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Role of screening tests for deep venous thrombosis in asymptomatic adults with acute spinal cord injury: an evidence-based analysis.

机译：在无症状成人急性脊髓损伤中深静脉血栓形成筛查试验的作用：基于证据的分析。

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STUDY DESIGN: Systematic review. OBJECTIVE: To examine the evidence to support practice guidelines for screening for DVT in asymptomatic adults with acute traumatic spinal cord injury (SCI) who undergo pharmacologic thromboprophylaxis. SUMMARY OF BACKGROUND DATA: Despite the fact that pharmacologic thromboprophylaxis has been widely used since the 1980s, deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) still account for approximately 10% of deaths during the first year following SCI. METHODS: MEDLINE and EMBASE were searched from the earliest achievable date to December 2005. We only included clinical studies that used a screening test for DVT and the gold standard diagnostic tests for DVT (i.e., lower limb venography) and for PE (i.e., lung arteriogram) in adults with traumatic SCI who underwent drug thromboprophylaxis during the acute stage after SCI. RESULTS: The search yielded 188 articles, of which 9 articles fulfilled the criteria to be included in our review. Screening for DVTwas performed in 3 randomized clinical trials and 6 case series. The protocol of these studies included the use of D-Dimer (1 of 9), I-labeled fibrinogen (2 of 9), ultrasound (1 of 9), impedance plethysmography (1 of 9), impedance plethysmography and Doppler in combination (1 of 9), Duplex (1 of 9) or venography (2 of 9) as screening test for DVT. Based on the pooled data of these studies, asymptomatic DVT was detected in 16.9% of SCI population. Only 4 studies reported the occurrence of PE in 4.4% of cases. CONCLUSION: There is insufficient evidence to support (or refute) a recommendation for routine screening for DVT in adults with acute traumatic SCI under thromboprophylaxis. However, there is level II-2 evidence that screening could detect asymptomatic DVT in 22.7% of those individuals. Although additional investigation is needed, we hypothesize that weekly screening for DVT during the first 13 weeks post-SCI could detect most of the asymptomatic DVT events in this patient population. D-Dimer, ultrasound,and MR venography could be considered as potentially useful screening tests for DVT in the SCI population in future research studies.
机译：研究设计：系统评价。目的：研究证据以支持对接受药理性血栓预防的无症状成人急性创伤性脊髓损伤（SCI）进行DVT筛查的实践指南。背景资料摘要：尽管自1980年代以来就已广泛使用药物性血栓预防措施，但深静脉血栓形成（DVT）和随后的肺栓塞（PE）仍占SCI后第一年死亡的约10％。方法：从最早实现日期到2005年12月，对MEDLINE和EMBASE进行了搜索。我们仅包括使用DVT筛查试验和DVT（即下肢静脉造影）和PE（即肺）的金标准诊断试验的临床研究动脉造影）在SCI急性期接受过药物血栓预防的SCI成年人。结果：搜索获得188篇文章，其中9篇文章符合我们的评价标准。在3个随机临床试验和6个病例系列中对DVT进行了筛查。这些研究的方案包括将D-二聚体（1/9），I标记的纤维蛋白原（2/9），超声（9/1），阻抗体积描记法（9/1），阻抗体积描记法和多普勒结合使用（ 9个中的1个），双工（9个中的1个）或静脉造影（9个中的2个）作为DVT的筛查测试。根据这些研究的汇总数据，在16.9％的SCI人群中检测到无症状DVT。仅4项研究报告了4.4％的病例中发生PE。结论：没有足够的证据支持（或驳斥）建议对血栓预防性急性外伤性脊髓损伤的成人进行常规DVT筛查。但是，有II-2级证据表明，筛查可以检测到22.7％的无症状DVT。尽管需要进行进一步的调查，但我们假设在SCI后的前13周每周筛查DVT可以检测到该患者人群中的大多数无症状DVT事件。在未来的研究中，D-二聚体，超声和MR静脉造影可被视为SCI人群DVT的潜在有用筛查方法。

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