Predicting the Development of Venous Thromboembolic Complications in Combat Burn Injury

BACKGROUND Venous thromboembolic complications (VTEC) are an urgent problem of modern military medicine and require constant improvement of methods for their prediction, prevention, diagnosis and treatment.

AIM to study the incidence of VTEC in casualties with combat burn injury and evaluate the possibility of predicting their development.

MATERIAL AND METHODS An analysis of treatment outcomes of 47 casualties with combat burn injury in the period from 2022 to September 2024 was carried out. All the patients were men, average age 27.3±3.1 years. The average severity of injuries on the Injury Severity Score (ISS) scale was 12.4±1.7 points.

Depending on the severity of the injuries received, the casualties were divided into 2 groups. Group I included 21 (44.7%) wounded with ISS ≤6; group II included 26 (55.3%) with ISS>6.

For casualties of group I, pharmacoprophylaxis of VTEC was carried out only in 2 cases; mechanical types of prophylaxis were not used. All casualties of group II were prescribed anticoagulant therapy in preventive and therapeutic dosages, mechanoprophylaxis — in the absence of contraindications.

To identify significant prognostic signs of VTEC development, multiple regression analysis was used, and ROC analysis was used to assess the ability of independent prognostic factors.

RESULTS Combined thermomechanical injuries were diagnosed in 25 (53.2%) wounded, isolated burn injury — in 22 (46.8%). Deep burns were detected in 19 (40.4%), of which 5 (26.3%) were in group I, 14 (73.7%) were in group II (p<0.001); thermal inhalation injury — in 10 (38.5%) patients of group II. With ISS≤6 (group I), venous thrombosis did not develop; with ISS≤6 (group II), a significant increase in VTEC was noted to 42.3% (χ²=9.4; p<0.002). Pulmonary embolism (PE) was present in 1 (2.1%) wounded person of group II.

Multiple regression analysis showed that of all the studied signs, only the severity of injuries on the ISS scale turned out to be a reliable prognostic indicator of the development of VTEC (p=0.000085). The area under the ROC curve was 0.829.

CONCLUSION 1. The incidence of VTEC in casualties with combat burn injury is 23.4%, PE — 2.1%.

2. The number of points on the Injury Severity Score is a reliable predictor of the development of VTEC (p=0.000085) and, according to the results of ROC analysis, has a good predictive ability for assessing the likelihood of developing VTEC in combat burn injury.

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