• Arthur M Carlin, James G Tyburski, Robert F Wilson, and Christopher Steffes.
• Department of Surgery, Detroit Receiving Hospital, Wayne State University School of Medicine, 3990 John R, Suite 400, Detroit, MI 48201, USA. acarlin@med.wayne.edu
• Arch Surg Chicago. 2002 May 1; 137 (5): 521-5; discussion 525-7.

HypothesisInsertion of inferior vena cava filters (IVCFs) can prophylactically reduce pulmonary embolism (PE) in trauma patients.DesignRetrospective review.SettingUrban, level I trauma center.PatientsTwo hundred blunt trauma patients undergoing IVCF placement.InterventionsIn 122 patients who had already been diagnosed as having deep vein thrombosis (DVT) (112 patients) and/or PE (22 patients), the insertion of the IVCF was considered "therapeutic." In 78 patients who had no evidence of DVT or PE but who were considered to be at high risk for a PE, the IVCF was considered "prophylactic."Main Outcome MeasuresIncidence of PE and related mortality and morbidity in therapeutic vs prophylactic IVCFs.ResultsThe number of prophylactic IVCFs inserted increased significantly from only 4% (3/68 cases) from 1991 through 1996, up to 57% (75/132 cases) from 1997 to June 2001. Although the mean +/- SD age (51 +/- 20 years vs 41 +/- 15 years; P<.001) was higher in the therapeutic group, there was no difference in the mean +/- SD Injury Severity Scores (20 +/- 12 vs 21 +/- 11). Therapeutic filters were placed much later after injury (mean +/- SD time, 11 +/- 7 vs 3 +/- 2 days; P<.001). The mortality rate was 11% (13/122 patients) in patients having a therapeutic IVCF, as compared with only 3% (2/78 patients) in those placed prophylactically (P =.07). None of the patients who had placement of a prophylactic IVCF developed subsequent PE. The incidence of PE decreased in all blunt trauma patients from 0.29% before 1997 to 0.15% after January 1, 1997, when 57% of the IVCF inserted were prophylactic (P =.06).ConclusionsProphylactic IVCFs should be inserted within 48 hours of injury in specific trauma patients at high risk for PE and with contraindications to anticoagulation.

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