Venous thromboembolism prophylaxis in traumatic brain injury after radiographic progression: a 6-year experience at a single Canadian Level 1 trauma Centre
Bibliographic record
Abstract
BACKGROUND: Patients with traumatic brain injury are at high risk for venous thromboembolism. Therefore, pharmacological prophylaxis for venous thromboembolism has become critical in managing trauma patients. Unfortunately, the decision to initiate prophylaxis in patients with radiographic progression must be carefully weighed against the risk of further progression of intracranial haemorrhage, with little evidence to support decision-making. METHODS: A retrospective review was performed at a Canadian Level 1 Trauma Centre from 2011-2017. Included adult patients had evidence of radiographic intracranial haemorrhage progression on repeat CT, and patients receiving prophylaxis were compared with those not having received prophylaxis. Regression analyses were performed to determine the decision-making process for providers when caring for these patients. RESULTS: 242 patients were included in the study, with 33.1% of these patients not receiving pharmacological prophylaxis during admission. Of those without prophylaxis, 1.2% developed deep vein thromboses, no patients with pulmonary emboli, compared with five patients in the prophylaxis group with pulmonary emboli. The probability of not receiving prophylaxis was higher if abbreviated injury score is greater or equal to 4, decreased in cases of pelvic fracture or solid organ injury, or if the patient required an operative procedure. CONCLUSION: Patients with isolated, non-operative severe traumatic brain injury may be at risk of not receiving pharmacologic prophylaxis for venous thromboembolism during hospital admission. This decision may place patients at greater risk of venous thromboembolism, and thereby increased morbidity and mortality. As such, further investigation and initiatives to improve pharmacologic prophylaxis in this patient population is warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".