Characterizing the relationship between age and venous thromboembolism in adult trauma patients: findings from the National Trauma Data Bank and the National Inpatient Sample

Anthony J Nastasi; Joseph K Canner; Brandyn D Lau; Michael B Streiff; Jonathan K Aboagye; Peggy S Kraus; Deborah B Hobson; Kyle J Van Arendonk; Elliott R Haut

doi:10.1016/j.jss.2017.04.033

Characterizing the relationship between age and venous thromboembolism in adult trauma patients: findings from the National Trauma Data Bank and the National Inpatient Sample

J Surg Res. 2017 Aug:216:115-122. doi: 10.1016/j.jss.2017.04.033. Epub 2017 May 5.

Authors

Anthony J Nastasi¹, Joseph K Canner², Brandyn D Lau³, Michael B Streiff⁴, Jonathan K Aboagye², Peggy S Kraus⁵, Deborah B Hobson⁶, Kyle J Van Arendonk², Elliott R Haut⁷

Affiliations

¹ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
² Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
³ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
⁴ The Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, Maryland; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁵ Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland.
⁶ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, Maryland; Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland.
⁷ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: [email protected].

PMID: 28807195
DOI: 10.1016/j.jss.2017.04.033

Abstract

Background: Venous thromboembolism (VTE) is a tremendous burden in health care. However, current guidelines lack recommendations regarding the prevention of VTE in older adult trauma patients. Furthermore, the appropriate method of modeling of age in VTE models is currently unclear.

Methods: Patients included in the National Trauma Data Bank (NTDB) between the years 2008 and 2014 and patients included in the National Inpatient Sample (NIS) between 2009 and 2013 were analyzed. Multiple logistic regression of VTE on age was performed.

Results: Of 3,598,881 patients in the NTDB, 34,202 (1.0%) were diagnosed with VTE compared to 5405 (1.1%) of the 505,231 patients in NIS. In both the fully adjusted NTDB and NIS model, age was positively associated with odds of VTE diagnosis under 65 years (NTDB, adjusted odds ratio [aOR]: 1.018, 95% confidence interval [CI]: 1.017-1.019, P < 0.001; NIS, aOR: 1.025, 95% CI 1.022-1.027, P < 0.001). In patients aged ≥65 years, age was negatively associated with odds of VTE diagnosis in the NTDB (aOR: 0.995, 95% CI: 0.992-0.999, P = 0.006) but not in the NIS (aOR: 0.998, 95% CI 0.994-1.002, P = 0.26).

Conclusions: Incidence of VTE among adult trauma patients steadily increases with age until 65 years, after which the odds of VTE appear to level off or even slightly decrease. These findings should be applied for improved modeling of VTE in trauma patients. The mechanism behind these findings should be explored before using them to update guidelines for standardized VTE prevention in older adults.

Keywords: Age; Trauma; Venous thromboembolism.

Publication types

Research Support, U.S. Gov't, P.H.S.
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Databases, Factual
Female
Humans
Incidence
Logistic Models
Male
Middle Aged
Risk Factors
Venous Thromboembolism / diagnosis
Venous Thromboembolism / epidemiology
Venous Thromboembolism / etiology*
Venous Thromboembolism / prevention & control
Wounds and Injuries / complications*
Young Adult