(1563) Matched Analysis of Time to VTE Prophylaxis in TBI Patients Admitted to the NSICU Versus TICU

Introduction: Previous data from our institution demonstrated that in trauma patients admitted to the neurosciences intensive care unit (NSICU) with traumatic brain injury (TBI) venous thromboembolism (VTE) prophylaxis was started sooner compared to those admitted to the trauma ICU (TICU). The purpose of this study was to investigate if a difference in the time to initiation of VTE prophylaxis remained when the groups were matched using a propensity score matching (PSM) analysis.

Methods: This was a matched analysis of a retrospective, cohort study. Adult trauma patients with intracerebral hemorrhage admitted to either the NSICU or TICU of an academic, level 1, trauma center between Jan 2020 and Dec 2021 were included. Patients that died within 24 hours or had a hospital length of stay (LOS) ≤ 1 day were excluded. Patients were matched using the following factors: age, sex, injury severity score (ISS), Glasgow coma score (GCS), penetrating injury, and craniotomy. Data were collected from the Trauma Quality Improvement Program database. The primary outcome was the amount of time (minutes) to the initiation of VTE prophylaxis.

Results: The total cohort included 281 patients. Unfractionated heparin (UFH) was the most commonly prescribed medication (n=307/414; 74.2%) for VTE prophylaxis. After PSM, 112 patients were included in each group. Median GCS was 14.5 in both groups. Patients admitted to the TICU had higher median ISS (19 [14, 25] vs. 16 [10, 25]). Time to VTE prophylaxis was longer in the NSICU group (372 [228, 578] vs. 272 [125, 467] minutes; p = 0.016) versus in patients admitted to the TICU.

Conclusions: In a matched analysis, patients with mild TBI experienced longer time to initiation of VTE prophylaxis if admitted to the NSICU compared to the TICU; however, the delay was not clinically significant given VTE prophylaxis was started early in both groups.