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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate Professor Charlotte Ebeling Barbier, Akademiska sjukhuset, Uppsala
- Second opponent: Associate Professor Knut Haakon Stensæth, NTNU
- Third member and chair of the evaluation committee: Associate Professor Peter Majak, University of Oslo
Chair of the Defence
Associate Professor Gunnar Sandbæk, Faculty of Medicine, University of Oslo
Principal Supervisor
Professor Nils Einar Kløw, Faculty of Medicine, University of Oslo
Summary
The use of inferior vena cava (IVC) filters to prevent pulmonary embolism (PE) after severe trauma is controversial. The practice varies between hospitals and countries, in part due to conflicting guidelines. Pharmacological thromboprophylaxis is an alternative but may increase the risk of serious bleeding.
The frequent use of IVC filters at Mayo Clinic (MN, USA) is different from the practice at OUS Ullevål (Oslo, Norway) where IVC filters are not used.
The primary aim was to investigate if prophylactic IVC filter placement in patients admitted with severe trauma altered the risk of PE, DVT, and mortality. We found that prophylactic placement of IVC filters neither reduced the incidence of PE nor mortality. However, IVC filter placement was associated with a higher incidence of DVT.
Lower extremity deep vein thrombosis (LE-DVT) is a common source of PE. Although sonography is the preferred initial examination for LE-DVT, indirect computed tomography venography (CTV) is a valuable alternative with some advantages in the trauma setting. However, CTV requires administration of a contrast medium and hemodynamic instability might affect examination quality and the optimal delay between the contrast administration and the scan.
The secondary aim was to investigate the impact of scan delay and patient factors on contrast enhancement and examination quality in CTV. We found that in CTV, contrast enhancement in deep veins increased progressively until 120 s after contrast administration, and thereafter remained stable for the next 90 s. Neither hemodynamic, nor other patient factors showed significant effect on the time-to-peak-contrast enhancement.
Additional information
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