Hwasoon Kim; Ok Min Cho; Hyo Im Cho; Ju Yeun Kim

doi:10.4040/jkan.2012.42.3.396

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Original Article
Risk Factors and Features of Critically Ill Patients with Deep Vein Thrombosis in Lower Extremities: Hwasoon Kim¹, Ok Min Cho², Hyo Im Cho³, Ju Yeun Kim³; Journal of Korean Academy of Nursing 2012;42(3):396-404.
DOI: https://doi.org/10.4040/jkan.2012.42.3.396
Published online: June 12, 2012

¹Professor Inha University, Incheon, Korea

²Master Student, Inha University, Incheon, Korea

³Ph D. Student, Inha University, Incheon, Korea

¹Professor Inha University, Incheon, Korea

²Master Student, Inha University, Incheon, Korea

³Ph D. Student, Inha University, Incheon, Korea

Address reprint requests to : Kim, Hwasoon Inha University, 253 Yonghyun-dong, Nam-gu, Incheon, Zip code: 402-751 Tel : +82-32-860-8208 Fax: +82-32-874-5880 E-mail: khs0618@inha.ac.kr

• Received: September 30, 2011 • Revised: October 17, 2011 • Accepted: May 29, 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
The purpose of this study was to identify the features, risk scores and risk factors for deep vein thrombosis in critically ill patients who developed deep vein thrombosis in their lower extremities.
Methods
The participants in this prospective descriptive study were 175 adult patients who did not receive any prophylactic medication or mechanical therapy during their admission in the intensive care unit.
Results
The mean age was 62.24 (± 17.28) years. Men made up 54.9% of the participating patients. There were significant differences in age, body mass index, and leg swelling between patients who developed deep vein thrombosis and those who did not have deep vein thrombosis. The mean risk score was 6.71(± 2.94) and they had on average 4.01(± 1.35) risk factors. In the multiple logistic regression, body mass index (odds ratio= 1.14) and leg swelling (odds ratio= 6.05) were significant predictors of deep vein thrombosis.
Conclusion
Most critically ill patients are in the potentially high risk group for deep vein thrombosis. However, patients who are elderly, obese or have leg edema should be closely assessed and more than one type of active prophylactic intervention should be provided.
Keywords: Critical illness; Venous thrombosis; Risk factors

Table 1.

Characteristics of Participants with DVT and without DVT (N=175)

Characteristics	Categories	n (%) or M±SD	DVT(+) (n=27)	DVT(-) (n=148)	χ² or F or t (p)
Age (yr)		62.24±17.28	69.56±12.57	60.91±17.72	-3.06 (.004)
BMI (kg/m²), (N=152)		22.29±3.95	24.35±4.5	21.98±3.78	-2.54 (.012)
ICU stay (days)		13.09±13.43	16.04±15.06	12.55±13.01	-1.24 (.215)
DVT risk scores		6.71±2.94	7.22±2.78	6.62±2.97	-0.98 (.330)
DVT risk level	low (0-1)	1 (0.6)	0 (0.0)	1 (0.7)
	Moderate (2)	7 (4.0)	1 (3.7)	6 (4.1)	(.865)^*
	High (3-4)	34 (19.4)	4 (14.8)	30 (20.3)
	Highest (≥5)	133 (76.0)	22 (81.5)	111 (75.0)
Gender	Male	96 (54.9)	17 (63.0)	79 (53.4)	0.85 (.405)
	Female	79 (45.1)	10 (37.0)	69 (46.6)
Ward	MICU	61 (35.0)	13 (48.1)	48 (32.7)	2.41(.130)
	SICU	113 (65.0)	14 (51.9)	99 (67.3)
Operation	No	118 (67.4)	20 (74.1)	98 (66.2)	0.64 (.507)
	Yes	57 (32.6)	7 (25.9)	50 (33.8)
Severity^†	Level 3	1 (0.6)	0 (0.0)	1 (0.7)	0.19 (.911)
	Level 4	26 (14.9)	4 (14.8)	22 (15.0)
	Level 5	147 (84.5)	23 (85.2)	124 (84.3)
Level of consciousness	Alert	38 (21.7)	5 (18.5)	33 (22.3)	1.54 (.674)
	Drowsy	45 (25.7)	6 (22.2)	39 (26.4)
	Stupor	31 (17.7)	7 (25.9)	24 (16.2)
	Coma/Sedation	61 (34.9)	9 (33.3)	52 (35.1)
Mortality	Death	31 (17.7)	4 (14.8)	27 (18.2)	0.18 (.668)
	Alive	144 (82.3)	23 (85.2)	121 (81.8)
Swollen legs	No	167 (95.4)	23 (85.2)	144 (97.3)	(.021)^*
	Yes	8 (4.6)	4 (14.8)	4 (2.7)
Pneumonia	No	156 (89.1)	23 (85.2)	133 (89.9)	(.501)^*
(<1 month)	Yes	19 (10.9)	4 (14.8)	15 (10.1)
History of prior major surgery	No	166 (94.9)	26 (96.3)	140 (94.6)	(1.000)^*
(<1 month)	Yes	9 (5.1)	1 (3.7)	8 (5.4)
Central venous	No	77 (44.0)	14 (51.9)	63 (42.6)	0.80 (.404)
access	Yes	98 (56.0)	13 (48.1)	85 (57.4)
Mechanical	No	55 (31.4)	8 (29.6)	47 (31.8)	0.04 (1.000)
ventilation	Yes	120 (68.6)	19 (70.4)	101 (68.2)
Malignancy	No	147 (84.0)	20 (74.1)	127 (85.8)	2.34 (.152)
(present or previous)	Yes	28 (16.0)	7 (25.9)	21 (14.2)
Chronic obstructive	No	169 (96.6)	25 (92.6)	144 (97.3)	(.232)^*
pulmonary disease	Yes	6 (3.4)	2 (7.4)	4 (2.7)
Patients confined to	No	133 (76.0)	20 (74.1)	113 (76.4)	0.07 (.809)
bed (>72 hours)	Yes	42 (24.0)	7 (25.9)	35 (23.6)

BMI=Body mass index; ICU=Intensive care unit; DVT=Deep vein thrombosis; MICU=Medical intensive care unit; SICU=Surgery intentive care unit.

^*Fisher's Exact test result;

^†Measured by Workload Management System for Critical Care Nurses (WMSCN).

Table 2.

Risk Factors and Scores of DVT in ICU Patients (N=175)

Risk factor	Risk score	n (%)
Currently at bed rest	1	131 (74.9)
Mechanical ventilator therapy		120 (68.6)
Age 41-60 yrs		55 (31.4)
Pneumonia (<1 month)		19 (10.9)
Prior major surgery (<1 month)		9 (5.1)
Swollen legs (current)		8 (4.6)
Acute myocardial infarction		6 (3.4)
Chronic obstructive pulmonary disease		6 (3.4)
Sepsis (<1 month)		2 (1.1)
Congestive heart failure (<1 month)		1 (0.6)
Central venous catheter	2	98 (56.0)
Major surgery (>45 minutes)		58 (33.1)
Age 61-74 yrs		55 (31.4)
Confined to bed (>72 hours)		42 (24.0)
Malignancy (present or previous)		28 (16.0)
Immobilizing plaster cast (<1 month)		3 (1.7)
Age over 75 yrs	3	45 (25.7)
Hip, pelvis or leg fracture (<1 month)		6 (3.4)
History of DVT/VE		1 (0.6)
Stroke (<1 month)	5	5 (2.9)
Multiple trauma (<1 month)		5 (2.9)
Acute spinal cord injury (paralysis,<1 month)		2 (1.1)
Elective major lower extremity arthroplasty		1 (0.6)

ICU=Intensive care unit.

Table 3.

The Predictors of Developing DVT in Lower Extremities

Characteristics	B	95% Confidence interval		Odds ratio	p
Characteristics	B	Lower	Upper	Odds ratio	p
BMI	0.13	1.00	1.28	1.14	.045
Swollen legs	1.80	1.30	28.16	6.05	.022

BMI=Body mass index.

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Risk Factors and Features of Critically Ill Patients with Deep Vein Thrombosis in Lower Extremities

J Korean Acad Nurs. 2012;42(3):396-404. Published online June 12, 2012

DOI: https://doi.org/10.4040/jkan.2012.42.3.396

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Risk Factors and Features of Critically Ill Patients with Deep Vein Thrombosis in Lower Extremities

Characteristics	Categories	n (%) or M±SD	DVT(+) (n=27)	DVT(-) (n=148)	χ² or F or t (p)
Age (yr)		62.24±17.28	69.56±12.57	60.91±17.72	-3.06 (.004)
BMI (kg/m²), (N=152)		22.29±3.95	24.35±4.5	21.98±3.78	-2.54 (.012)
ICU stay (days)		13.09±13.43	16.04±15.06	12.55±13.01	-1.24 (.215)
DVT risk scores		6.71±2.94	7.22±2.78	6.62±2.97	-0.98 (.330)
DVT risk level	low (0-1)	1 (0.6)	0 (0.0)	1 (0.7)
	Moderate (2)	7 (4.0)	1 (3.7)	6 (4.1)	(.865)^*
	High (3-4)	34 (19.4)	4 (14.8)	30 (20.3)
	Highest (≥5)	133 (76.0)	22 (81.5)	111 (75.0)
Gender	Male	96 (54.9)	17 (63.0)	79 (53.4)	0.85 (.405)
	Female	79 (45.1)	10 (37.0)	69 (46.6)
Ward	MICU	61 (35.0)	13 (48.1)	48 (32.7)	2.41(.130)
	SICU	113 (65.0)	14 (51.9)	99 (67.3)
Operation	No	118 (67.4)	20 (74.1)	98 (66.2)	0.64 (.507)
	Yes	57 (32.6)	7 (25.9)	50 (33.8)
Severity^†	Level 3	1 (0.6)	0 (0.0)	1 (0.7)	0.19 (.911)
	Level 4	26 (14.9)	4 (14.8)	22 (15.0)
	Level 5	147 (84.5)	23 (85.2)	124 (84.3)
Level of consciousness	Alert	38 (21.7)	5 (18.5)	33 (22.3)	1.54 (.674)
	Drowsy	45 (25.7)	6 (22.2)	39 (26.4)
	Stupor	31 (17.7)	7 (25.9)	24 (16.2)
	Coma/Sedation	61 (34.9)	9 (33.3)	52 (35.1)
Mortality	Death	31 (17.7)	4 (14.8)	27 (18.2)	0.18 (.668)
	Alive	144 (82.3)	23 (85.2)	121 (81.8)
Swollen legs	No	167 (95.4)	23 (85.2)	144 (97.3)	(.021)^*
	Yes	8 (4.6)	4 (14.8)	4 (2.7)
Pneumonia	No	156 (89.1)	23 (85.2)	133 (89.9)	(.501)^*
(<1 month)	Yes	19 (10.9)	4 (14.8)	15 (10.1)
History of prior major surgery	No	166 (94.9)	26 (96.3)	140 (94.6)	(1.000)^*
(<1 month)	Yes	9 (5.1)	1 (3.7)	8 (5.4)
Central venous	No	77 (44.0)	14 (51.9)	63 (42.6)	0.80 (.404)
access	Yes	98 (56.0)	13 (48.1)	85 (57.4)
Mechanical	No	55 (31.4)	8 (29.6)	47 (31.8)	0.04 (1.000)
ventilation	Yes	120 (68.6)	19 (70.4)	101 (68.2)
Malignancy	No	147 (84.0)	20 (74.1)	127 (85.8)	2.34 (.152)
(present or previous)	Yes	28 (16.0)	7 (25.9)	21 (14.2)
Chronic obstructive	No	169 (96.6)	25 (92.6)	144 (97.3)	(.232)^*
pulmonary disease	Yes	6 (3.4)	2 (7.4)	4 (2.7)
Patients confined to	No	133 (76.0)	20 (74.1)	113 (76.4)	0.07 (.809)
bed (>72 hours)	Yes	42 (24.0)	7 (25.9)	35 (23.6)

Risk factor	Risk score	n (%)
Currently at bed rest	1	131 (74.9)
Mechanical ventilator therapy		120 (68.6)
Age 41-60 yrs		55 (31.4)
Pneumonia (<1 month)		19 (10.9)
Prior major surgery (<1 month)		9 (5.1)
Swollen legs (current)		8 (4.6)
Acute myocardial infarction		6 (3.4)
Chronic obstructive pulmonary disease		6 (3.4)
Sepsis (<1 month)		2 (1.1)
Congestive heart failure (<1 month)		1 (0.6)
Central venous catheter	2	98 (56.0)
Major surgery (>45 minutes)		58 (33.1)
Age 61-74 yrs		55 (31.4)
Confined to bed (>72 hours)		42 (24.0)
Malignancy (present or previous)		28 (16.0)
Immobilizing plaster cast (<1 month)		3 (1.7)
Age over 75 yrs	3	45 (25.7)
Hip, pelvis or leg fracture (<1 month)		6 (3.4)
History of DVT/VE		1 (0.6)
Stroke (<1 month)	5	5 (2.9)
Multiple trauma (<1 month)		5 (2.9)
Acute spinal cord injury (paralysis,<1 month)		2 (1.1)
Elective major lower extremity arthroplasty		1 (0.6)

Characteristics	B	95% Confidence interval		Odds ratio	p
Characteristics	B	Lower	Upper	Odds ratio	p
BMI	0.13	1.00	1.28	1.14	.045
Swollen legs	1.80	1.30	28.16	6.05	.022

Table 1. Characteristics of Participants with DVT and without DVT (N=175)

BMI=Body mass index; ICU=Intensive care unit; DVT=Deep vein thrombosis; MICU=Medical intensive care unit; SICU=Surgery intentive care unit.

Fisher's Exact test result;

†

Measured by Workload Management System for Critical Care Nurses (WMSCN).

Table 2. Risk Factors and Scores of DVT in ICU Patients (N=175)

ICU=Intensive care unit.

Table 3. The Predictors of Developing DVT in Lower Extremities

BMI=Body mass index.