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Original article
Does diabetes type increase the odds of venous thromboembolism following traumatic injury?
  1. Jan Leonard1,2,3,4,
  2. Lisa M Caputo1,2,3,
  3. Matthew M Carrick5,
  4. Denetta S Slone6,7,
  5. Charles W Mains4,7,8,
  6. David Bar-Or1,2,3,4,7
  1. 1Department of Trauma Research, Medical Center of Plano, Plano, Texas, USA
  2. 2Department of Trauma Research, Swedish Medical Center, Englewood, Colorado, USA
  3. 3Department of Trauma Research, St. Anthony Hospital, Lakewood, Colorado, USA
  4. 4Department of Trauma Research, Penrose Hospital, Colorado Springs, Colorado, USA
  5. 5Trauma Services Department, Medical Center of Plano, Plano, Texas, USA
  6. 6Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
  7. 7Rocky Vista University, Parker, Colorado, USA
  8. 8Trauma Services Department, St. Anthony Hospital, Lakewood, Colorado, USA
  1. Correspondence to Dr David Bar-Or, Department of Trauma Research, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO 80113, USA; dbaror{at}ampiopharma.com

Abstract

Background Venous thromboembolism (VTE) remains a clinically significant complication after trauma even though screening and prophylaxis strategies for at-risk patients have substantially reduced incidence. Our study sought to determine if diabetes, a condition that promotes thrombi formation, is associated with developing a VTE in trauma patients.

Methods The registries of 2 level I and a level II trauma centers were retrospectively reviewed for consecutively admitted trauma patients over a 6-year period. Demographics, VTE risk factors, injury characteristics, and VTE incidence were univariately compared between patients with insulin-dependent diabetes mellitus (IDDM), non-insulin-dependent diabetes mellitus (NIDDM), and no diabetes. Stepwise logistic regression was performed to identify independent predictors of VTE; results were further stratified by age (<65 and ≥65 years) and presented as adjusted ORs (AOR).

Results Of the 26 934 total patients, 779 (2.9%) had IDDM, 2052 (7.6%) had NIDDM, and the remaining 89.5% were without diabetes. VTE incidence was 3.6%, 2.4%, and 2.2%, in IDDM, NIDDM, and non-diabetes, respectively (p=0.02). After adjustment for established and significant risk factors, neither IDDM (AOR=1.43, 95% CI 0.95 to 2.15, p=0.09) nor NIDDM (AOR=1.03, 95% CI 0.75 to 1.40, p=0.88) was associated with increased odds of developing a VTE. Patients ≥65 years developed VTE more frequently than those <65 years (2.5% vs 2.1%, p=0.04). Among patients <65 years, IDDM was significantly predictive of VTE (AOR=1.86, 95% CI 1.01–3.41, p=0.045), but NIDDM was not. For patients ≥65 years, neither type of diabetes was predictive of VTE.

Conclusions VTE incidence was ∼2 times higher among injured patients <65 years with IDDM versus no diabetes. Overall, we did not find an increased risk of VTE in patients with any diabetes. Additional studies are needed before a recommendation on VTE screening or prophylaxis in IDDM can be made.

Level of evidence Level III, therapeutic/care management.

  • diabetes mellitus
  • Venous thromboembolism
  • trauma/ critical care

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/tsaco-2016-000003

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