Is thromboprophylaxis appropriately prescribed in patients immobilised after lower limb injury – An audit based on national guidelines

Title : Is thromboprophylaxis appropriately prescribed in patients immobilised after lower limb injury – An audit based on national guidelines

Abstract:

Introduction: Venous Thrombo Embolism (VTE) post lower limb immobilisation is a well-known phenomena and one that causes significant morbidity. It can be prevent through appropriate prescribing of VTE prophylaxis. An audit was carried out at a major trauma centre using the Thromboprophylaxis In Lower Limb Injury (TILLI) guideline which is based on the NICE NG89 guideline. The guideline outlines steps that can be taken, crucially encouraging clinicians to calculate a TRiPCast score and prescribe VTE prophylaxis appropriately.

Methods: A single cycle of the audit was completed by retrospectively collecting data on patients presenting to Virtual Fracture Clinic (VFC). The dataset included patient demographics, type
of injury, TriPCast score (if calculated), if TRiPCast score was calculated correctly, any applicable exclusion criteria for anticoagulation, type of anticoagulation prescribed and duration of anticoagulation.

Results: A total of 197 patients were found to have attended VFC between 1st May 2026 and 15th May 2026. 64 patients were found to have lower limb immobilisation post injury. 32 (52%) patients had TRipCast scores documented in the notes. Of those patients, 29 (91%) patients were found to have correct TRipCast scores documented. Majority of patients (60%) had the correct anticoagulation given, however only 25% were given the correct duration of anticoagulation. The exclusion criteria was applicable to 2 patients.

Conclusion: Majority of patients were being assessed for risk of developing VTE through appropriate use of TRiPCast score (52% vs 48%) with most patients having the correct scores documented (91%) and also being given the correct anticoagulation (60%). However, most patients did not receive the correct duration of anticoagulation (25% vs. 75%). Therefore, there is room for improvement. A further audit cycle is planned after the introduction of a poster in order to improve compliance. This poster will be disseminated to the trauma and orthopaedics department along with the Emergency department and Minor Injuries Unit.

Biography:

Rahim Nawaz Hussain graduated from Cardiff University in 2020 and completed his foundation programme in the West midlands South Deanery. After which he worked as a clinical teaching fellow at Worcester Acute Hospitals NHS trust. During this time he successfully completed his postgraduate certification in medical education. He has recently completed his core surgical training in the West Midlands deanery and has completed his MRCS during this time as well. He has an interest in pursuing higher surgical training in Trauma and Orthopaedics.