A nomogram for predicting risk factors for lower limb deep venous thrombosis in elderly postoperative patients with severe traumatic brain injury in the intensive care unit
Restricted accessResearch articleFirst published online July, 2025
A nomogram for predicting risk factors for lower limb deep venous thrombosis in elderly postoperative patients with severe traumatic brain injury in the intensive care unit
To investigate the incidence and risk factors for lower limb deep venous thrombosis in elderly postoperative patients with severe traumatic brain injury in the intensive care unit.
Design
A retrospective study.
Methods
Four hundred and one elderly patients (defined as aged ≥60 years) with severe traumatic brain injury who had undergone surgery and were admitted to the intensive care unit were enrolled in this study. We collected data on the incidence of lower extremity deep vein thrombosis and analyzed its influencing factors. Binary logistic regression analysis was employed to assess the associations between these factors and the occurrence of DVT. A nomogram was developed, and calibration curves were utilized to evaluate the model’s accuracy. Additionally, a receiver operating characteristic curve was employed to assess the model’s clinical discriminatory power.
Results
The incidence of lower limb deep venous thrombosis in elderly postoperative patients with severe traumatic brain injury in the intensive care unit was 25.69%. The final nomogram included age, intraoperative hypothermia, intraoperative bleeding volume, surgery time, D-dimer level, any organ failure, and body mass index as independent risk factors. The standard curve fit well with the calibrated prediction curve. The area under the receiver operating characteristic curve was 0.976 (95% CI: 0.958–0.994), and the model had good discrimination ability and reliability.
Conclusions
The risk factors for lower limb deep venous thrombosis in elderly postoperative patients with severe traumatic brain injury in the intensive care unit can be preliminarily assessed via the nomogram prediction model. This information may help guide medical staff in making reasonable decisions regarding the management of deep vein thrombosis prophylaxis.
Patient or Public Contribution
Elderly postoperative patients with severe traumatic brain injury in the intensive care unit participated in the retrospective investigation of this study.
De Cássia Almeida VieiraRSilveiraJCPPaivaWS, et al.Prognostic models in severe traumatic brain injury: a systematic review and meta-analysis. Neurocrit Care2022; 37(3): 790–805. DOI: 10.1007/s12028-022-01547-7.
2.
CapizziAWooJVerduzco-GutierrezM. Traumatic brain injury: an overview of epidemiology, pathophysiology, and medical management. Med Clin North Am2020; 104(2): 213–238. DOI: 10.1016/j.mcna.2019.11.001.
3.
ChenDLuoJZhangC, et al.Venous thrombus embolism in polytrauma: special attention to patients with traumatic brain injury. J Clin Med2023; 12(5): 1716. DOI: 10.3390/jcm12051716.
EngbersMJvan Hylckama VliegARosendaalFR. Venous thrombosis in the elderly: incidence, risk factors and risk groups. J Thromb Haemost2010; 8(10): 2105–2112.
6.
LiLZhenJHuangL,et al.The risk factors for deep venous thrombosis in critically ill older adult patients: a subgroup analysis of a prospective, multicenter, observational study. BMC Geriatr2022; 22(1): 977.
7.
ChenYQinXQS. Development and evaluation of a prediction model for lower limb deep venous thrombosis in critically ill patients. J Nurs Sci2021; 36(6): 35–38.
8.
SunMLFengYPHuangJ, et al.Clinical features of hospitalized patients with deep venous thrombosis. Zhonghua Nei Ke Za Zhi2017; 56(12): 914–918.
9.
SchleimerKBarbatiMEGrommesJ, et al.Update on diagnosis and treatment strategies in patients with post-thrombotic syndrome due to chronic venous obstruction and role of endovenous recanalization. J Vasc Surg Venous Lymphat Disord2019; 7(4): 592–600.
10.
ZhuL. Analysis of related risk factors for deep vein thrombosis after urology surgery. Frontiers in Medical Science Research2022; 4(1): 47–51.
11.
MargolickJDandurandCDuncanK, et al.A systematic review of the risks and benefits of venous thromboembolism prophylaxis in traumatic brain injury. Can J Neurol Sci2018; 45(4): 432–444. DOI: 10.1017/cjn.2017.275.
12.
ByrneJPWitiwCDSchusterJM, et al.Association of venous thromboembolism prophylaxis after neurosurgical intervention for traumatic brain injury with thromboembolic complications, repeated neurosurgery, and mortality. JAMA Surg2022; 157(3): e215794. DOI: 10.1001/jamasurg.2021.5794.
13.
VellaMACrandallMLPatelMB. Acute management of traumatic brain injury. Surg Clin North Am2017; 97(5): 1015–1030. DOI: 10.1016/j.suc.2017.06.003.
14.
FirschingRRickelsEMauerUM, et al.Guidelines for the treatment of head injury in adults. J Neurol Surg Cent Eur Neurosurg2017; 78(5): 478–487.
15.
Vascular Surgery Group of the Chinese Medical Association Surgery Branch. Guidelines for the diagnosis and treatment of deep vein thrombosis (3rd edition). Chin J Vasc Surg2017; 002: 201–208.
16.
BartlettMAMauckKFStephensonCR, et al.Perioperative venous thromboembolism prophylaxis. Mayo Clin Proc2020; 95(12): 2775–2798.
17.
KellyBMYoderBMTangCT, et al.Venous thromboembolic events in the rehabilitation setting. Pharm Manag PM R2010; 2(7): 647–663. DOI: 10.1016/j.pmrj.2010.03.029.
18.
NgACChowVYongAS, et al.Prognostic impact of the Charlson comorbidity index on mortality following acute pulmonary embolism. Respiration2013; 85(5): 408–416. DOI: 10.1159/000342024.
19.
SkrifvarsMBBaileyMPresneillJ, et al.Venous thromboembolic events in critically ill traumatic brain injury patients. Intensive Care Med2017; 43(3): 419–428.
20.
HachemLDMansouriAScalesDC, et al.Anticoagulant prophylaxis against venous thromboembolism following severe traumatic brain injury:a prospective observational study and systematic review of the literature. Clin Neurol Neurosurg2018; 175: 68–73.
21.
PrandoniPBarbarSMilanM, et al.The risk of recurrent thromboembolic disorders in patients with unprovoked venous thromboembolism:new scenarios and opportunities. Eur J Intern Med2014; 25(1): 25–30.
GoelRBoissonneaultAGrissomH, et al.Impact of intraoperative hypothermia on transfusion requirements in patients with pelvic and acetabular trauma. J Orthop Trauma2021; 35(12): 632–636.
24.
SesslerDI. Mild perioperative hypothermia. N Engl J Med1997; 336(24): 1730–1737.
25.
YiJLeiYXuS, et al.Intraoperative hypothermia and its clinical outcomes in patients undergoing general anesthesia: national study in China. PLoS One2017; 12(6): e0177221.
LeviM. Hemostasis and thrombosis in extreme temperatures (hypo- and hyperthermia). Semin Thromb Hemost2018; 44(7): 651–655.
28.
SchmuckenschlagerAPirabeAAssingerA, et al.Platelet count, temperature and pH value differentially affect hemostatic and immunomodulatory functions of platelets. Thromb Res2023; 223: 111–122.
29.
CaiJMengXWangC, et al.The cold effects on circulatory inflammation, thrombosis and vasoconstriction in type 2 diabetic patients. Sci Total Environ2016; 568: 271–277.
30.
StreiffMBAgnelliGConnorsJM, et al.Guidance for the treatment of deep vein thrombosis and pulmonary embolism. J Thromb Thrombolysis2016; 41(1): 32–67.
31.
LassenMRAgenoWBorrisLC, et al.Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med2008; 358(26): 2776–2786.
32.
BanksPABollenTLDervenisC, et al.Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut2013; 62: 102–111.
33.
JohnsonCDAbu-HilalM. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut2004; 53(9): 1340–1344.
34.
MaatmanTKMcGuireSPLewellenKA, et al.Prospective analysis of the mechanisms underlying ineffective deep vein thrombosis prophylaxis in necrotizing pancreatitis. J Am Coll Surg2021; 232(1): 91–100.
35.
Di NisioMvan EsNBullerHR. Deep vein thrombosis and pulmonary embolism embolism. Lancet2016; 388: 3060–3073.
36.
KearonCAgenoWCannegieterSC, et al.Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost2016; 14: 1480–1483.
37.
AlhassanSPelinescuAGandhiV, et al.Clinical presentation and risk factors of venous thromboembolic disease. Crit Care Nurs Q2017; 40: 201–209.
38.
GuptaESiddiqiFSKunjalR, et al.Association between aspirin use and deep venous thrombosis in mechanically ventilated ICU patients. J Thromb Thrombolysis2017; 44(3): 330–334.
39.
LiJRenXZhuX, et al.Clinical predictive factors of lower extremity deep vein thrombosis in relative high-risk patients after neurosurgery: a retrospective study. Dis Markers2020; 2020: 5820749.
40.
KamolratanapiboonKTantanateC. Inappropriate use of D-dimer and impact on the test characteristics for deep vein thrombosis exclusion. Scand J Clin Lab Invest2019; 79(6): 431–436.
41.
LiXKeLDongJ, et al.Significantly different clinical features between hypertriglyceridemia and biliary acute pancreatitis: a retrospective study of 730 patients from a tertiary center. BMC Gastroenterol2018; 18(1): 89.
42.
ChristiansenSCLijferingWMNaessIA, et al.The relationship between body mass index, activated protein C resistance and risk of venous thrombosis. J Thromb Haemost2012; 10(9): 1761–1767.
43.
NunezJMBecherRDReboGJ, et al.Prospective evaluation of weight-based prophylactic enoxaparin dosing in critically ill trauma patients: adequacy of AntiXa levels is improved. Am Surg2015; 81(6): 605–609.
44.
KoAHaradaMYBarmparasG, et al.Association between enoxaparin dosage adjusted by anti-factor Xa trough level and clinically evident venous thromboembolism after trauma. JAMA Surg2016; 151(11): 1006–1013.
45.
CookDDouketisJMeadeM, et al.Venous thromboembolism and bleeding in critically ill patients with severe renal insufficiency receiving dalteparin thromboprophylaxis: prevalence, incidence and risk factors. Crit Care2008; 12(2): R32.
46.
SchünemannHJCushmanMBurnettAE, et al.American Society of Hematology 2018 guidelines for management of deep venous thrombosis: prophylaxis for hospitalized and non-hospitalized medical patients. Blood Adv2018; 2(22): 3198–3225.
47.
HobsonDBChangTYAboagyeJK, et al.Prevalence of graduated compression stocking-associated pressure injuries in surgical intensive care units. J Crit Care2017; 40: 1–6.
48.
KahnSRLimWDunnAS, et al.Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines. Chest2017; 148(4): 651–673.
49.
LiangGZLiXSXuQJ, et al.Development and validation of a nomogram model for predicting the risk of venous thromboembolism in lymphoma patients undergoing chemotherapy:a prospective cohort study conducted in China. Ann Med2023; 55(2): 2275665. DOI: 10.1080/07853890.2023.2275665.
50.
ZhuYMWangJYXuBH. A novel prognostic nomogram for predicting survival of hormone receptor-positive and HER2 negative advanced breast cancer among the Han-population. Front Oncol2022; 12: 918759. DOI: 10.3389/fonc.2022.918759.
