Deep vein thrombosis - Prevalence and risk factors in rehabilitation admissions with brain injury

Objective: To determine the prevalence and risk factors of deep vein thrombosis (DVT) among neurorehabilitation admissions with acquired brain injury (BI). Methods: In this prospective, sequential case series, 709 consecutive initial neurorehabilitation patients with BI < 120 days-including, traumatic brain injury (TBI; n = 360), intracranial hemorrhage (ICH; n = 213), primary brain tumor (n = 66), and hypoxia/other BI (n = 70)-were screened for evidence of DVT with lower extremity venous duplex ultrasonography (VDU). The admission screening protocol combined VDU and a commercial D-dimer (Dimertest(R) [DDLx]) latex agglutination assay. DVT was considered present based upon VDU results only. Results: DVT prevalence was 11.1%, and was higher with brain tumor (21.2%) and ICH (16%) then with TBI (6.7%) (chi(2) test; p = 0.001). DVT risk factors identified by multivariable logistic regression analysis in the overall sample included older age (p = 0.002), type of BI (p = 0.04), DDLx (p = 0.0001), and greater postinjury duration (p = 0.0001), with a trend observed regarding lower Functional Independence Measure (FIM) locomotion (FIM-Loco) subscale score (p = 0.07) However, risk factors also varied with type of BI. Among patients with TBI, only DDLx (p = 0.001) and greater postinjury duration (p 0.001) were associated with DVT. Conclusions: Admission venous duplex ultrasonography revealed occult proximal lower extremity deep vein thrombosis in 11% of neurorehabilitation patients with acquired brain injury. Deep vein thrombosis risk is multifactorial in this heterogenous patient population, with relative factor risk influenced by type of acquired brain injury. Semiquantitative D-dimer latex agglutination assay correlated significantly with presence of deep vein thrombosis.