Impact of implementing a venous thromboembolism guideline and electronic health records order set on venous thromboembolism rates in trauma patients: A multicenter study

Janet S Lee; Emily Johnson; Nathan H Schmoekel; Robert C McIntyre Jr; Franklin L Wright; Michael W Cripps; Chris Cribari; Warren C Dorlac; Lacey N LaGrone; Valerie Brockman; Tracy Cotner-Pouncy; Thomas J Schroeppel

doi:10.1097/TA.0000000000004628

Impact of implementing a venous thromboembolism guideline and electronic health records order set on venous thromboembolism rates in trauma patients: A multicenter study

J Trauma Acute Care Surg. 2025 Apr 15. doi: 10.1097/TA.0000000000004628. Online ahead of print.

Authors

Janet S Lee¹, Emily Johnson, Nathan H Schmoekel, Robert C McIntyre Jr, Franklin L Wright, Michael W Cripps, Chris Cribari, Warren C Dorlac, Lacey N LaGrone, Valerie Brockman, Tracy Cotner-Pouncy, Thomas J Schroeppel

Affiliation

¹ From the Department of Trauma and Acute Care Surgery (J.S.L., E.J., N.H.S., V.B., T.J.S.), UCHealth Memorial Hospital, Colorado Springs; Department of Surgery (J.S.L., E.J., R.C.M., F.L.W., M.W.C.), University of Colorado Anschutz Medical Campus, Aurora; and Department of Trauma and Acute Care Surgery (C.C., W.C.D., L.N.L., T.C.-P.), UCHealth Medical Center of the Rockies, Loveland, Colorado.

PMID: 40232170
DOI: 10.1097/TA.0000000000004628

Abstract

Background: Appropriate chemical prophylaxis can reduce the risk of venous thromboembolism (VTE) in trauma patients. A system-wide VTE clinical practice guideline (CPG) and electronic health record (EHR)-based VTE prophylaxis order set were implemented. The CPG provided guidelines based on bleeding risk, recommended earlier initiation of chemical prophylaxis, and favored low-molecular-weight heparin (LMWH). The purpose of this study was to evaluate the impact of VTE CPG and prophylaxis order set on the rate of VTE.

Methods: A retrospective review was performed on trauma patients 15 years or older admitted to three trauma centers between July 2018 and December 2021. Exclusion criteria included burn injury, readmission, length of stay <2 days, and withdrawal of care. The VTE CPG and EHR order set were implemented in November 2020, and a pre-implementation/postimplementation (POST) comparison was conducted.

Results: A total of 12,479 patients were included. There were no differences in age, sex, and Injury Severity Score. The POST group had a higher usage of LMWH (64.0 vs. 67.5%, p < 0.01), a lower rate of no prophylaxis (17.2 vs. 12.5%, p < 0.01), and a shorter time to prophylaxis (29.4 vs. 25.9 hours, p < 0.01). The rates of VTE (1.6 vs. 1.0%, p < 0.01) and deep vein thrombosis (1.1 vs. 0.7%, p = 0.03) were lower in the POST group. There was no difference in the rate of pulmonary embolism (0.6 vs. 0.4%, p = 0.06). The POST group had a higher mortality (0.7 vs. 1.1%, p = 0.03) on univariable analysis, but there were no differences between groups on adjusted analysis. Independent predictors of VTE were longer time to VTE prophylaxis, higher Injury Severity Score, ventilator-associated pneumonia, and longer hospital length of stay. Use of LMWH and postintervention period were protective from VTE.

Conclusions: The implementation of a system-wide VTE CPG and EHR-based prophylaxis order set were associated with a reduced incidence of VTE in trauma patients without an associated mortality difference.

Level of evidence: Prognostic and Epidemiological; Level IV.

Keywords: Venous thromboembolism; clinical practice guideline; computer-based order set; trauma.