• Onur Berber, Aswin Vasireddy, Obi Nzeako, and Adel Tavakkolizadeh.
• Trauma and Orthopaedic Department, King's College Hospital NHS Foundation Trust, United Kingdom. Electronic address: oberber@gmail.com.
• Injury. 2017 Jul 1; 48 (7): 1400-1404.

ObjectivesThe aim of this study was to assess the impact on practice of vena cava filter insertion guidelines (Eastern Association for the Surgery of Trauma: practice management guidelines).DesignThe study was performed at a level 1 trauma centre with data from the 'Trauma Audit and Research Network' cross-referenced to hospital data.ResultsA total of 1138 specific 'high-risk' major trauma patients were identified over a 6-year period. The mean age was 46 years (18-102) and the male to female ratio was 3.3:1. The average Injury Severity Score was 23.6 (4-75). The overall DVT rate was 2.6% and the PE rate was 1.8%. A retrievable IVC filter was inserted in 42 cases (3.8%). The filter retrieval rate was 23.8% at a mean of 68.5days (4-107). Only one complication was reported of a breakthrough PE despite filter. Applying the EAST guidelines to this cohort would have suggested filter insertion in 279 (24.6%) cases. The kappa concordance value between observed practice and the 'EAST filter group' was 0.103 (poor). The PE rate in the 'EAST filter group' was 2.2% vs 1.6% in the 'no filter group' (p=0.601, no statistical difference) and the observed odds ratio was 0.814 (95% CI 0.413, 1.602).ConclusionThe EAST guidelines are useful but may be overestimating the need for filter insertion.Copyright © 2017 Elsevier Ltd. All rights reserved.

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