{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T01:30:39Z","timestamp":1787275839439,"version":"build-2736575974"},"reference-count":20,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"unspecified","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2025,10,9]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Best practice guidelines from trauma-focused organizations support early (&lt;72\u2009hours) venous thromboembolism (VTE) chemoprophylaxis initiation in traumatic brain injury (TBI) patients. Recent literature suggests that an even more aggressive initiation (24\u2009hours) is safe and efficacious. It is unknown how current practice aligns with the existing literature and best practice guidelines. We performed a national survey to characterize variation in trauma surgeons\u2019 reported practices and attitudes regarding VTE chemoprophylaxis initiation in TBI patients with the hypothesis that they will vary widely.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All 1700 American Association for the Surgery of Trauma members were surveyed online. Members who routinely cared for patients with TBI were asked to proceed with the survey. Descriptive data were reported. The questions characterized institutional guidelines, and if none existed, individual practice patterns regarding goal timeline of VTE chemoprophylaxis in TBI patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>374 members (22%) completed the survey. Most respondents worked at academic institutions (40%) and represented a level one trauma center (44%). Enoxaparin was the most common VTE chemoprophylactic (73%) with most using weight-based dosing (76%) and anti-Xa testing (75%). Institutional policies that included a protocol for VTE chemoprophylaxis initiation in TBI patients were used by 86% of respondents. In those with established protocols, 59% reported being mostly compliant. Reasons for delay of VTE chemoprophylaxis included worry about progression of TBI and disagreement with consulting services. 293 (80%) of respondents reported protocolized repeat head CT within 4\u201312\u2009hours after initial CT (60%). In response to a clinical scenario, 43% of respondents reported that their goal timeline for initiating VTE prophylaxis was within 24 hours of a stable head CT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite national guidelines, substantial variation remains in the timing of VTE chemoprophylaxis in TBI patients. Passive strategies, such as institutional guidelines alone, are insufficient. Institutions must adopt more effective implementation tactics\u2014including protocol-enforced order sets, automated clinical decision support, and shared governance models with ancillary services\u2014to ensure timely, evidence-based care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>Level V.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tsaco-2024-001708","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T07:25:35Z","timestamp":1761290735000},"page":"e001708","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Variation exists in venous thromboembolism prophylaxis in traumatic brain injury despite national guidelines: insights from a recent AAST survey study"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7147-2281","authenticated-orcid":false,"given":"Keith Walter","family":"Burczak","sequence":"first","affiliation":[{"name":"The University of Texas Health Science Center at Houston, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4655-2527","authenticated-orcid":false,"given":"Jan-Michael","family":"Van Gent","sequence":"additional","affiliation":[{"name":"Division of Trauma and Surgical Critical Care, The University of Texas Health Science Center at Houston, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1498-2458","authenticated-orcid":false,"given":"Devi","family":"Bavishi","sequence":"additional","affiliation":[{"name":"General Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle E","family":"Hatton","sequence":"additional","affiliation":[{"name":"Surgery, University of Texas McGovern Medical School, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6086-8966","authenticated-orcid":false,"given":"Patrick B","family":"Murphy","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin, Milwaukee, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4618-088X","authenticated-orcid":false,"given":"Asanthi","family":"Ratnasekera","sequence":"additional","affiliation":[{"name":"Surgery, Christiana Care Health Services Inc, Newark, Delaware, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W","family":"Clements","sequence":"additional","affiliation":[{"name":"Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1227-2420","authenticated-orcid":false,"given":"Rachel S","family":"Morris","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin, Milwaukee, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8079-5565","authenticated-orcid":false,"given":"Christopher","family":"Tignanelli","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Minnesota System, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4184-6742","authenticated-orcid":false,"given":"Bryan A","family":"Cotton","sequence":"additional","affiliation":[{"name":"Surgery, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4150-5956","authenticated-orcid":false,"given":"Thaddeus J","family":"Puzio","sequence":"additional","affiliation":[{"name":"General Surgery, University of Texas McGovern Medical School, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"2026010700453528000_10.4.e001708.1","first-page":"475","article-title":"Direct medical costs of venous thromboembolism and subsequent hospital readmission rates: an administrative claims analysis from 30 managed care organizations","volume":"13","author":"Spyropoulos","year":"2007","journal-title":"J Manag Care 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Increase the Risk of Intracranial Hematoma Progression in Patients with Isolated Severe Traumatic Brain Injury","volume":"43","author":"St\u00f6rmann","year":"2019","journal-title":"World J Surg"},{"key":"2026010700453528000_10.4.e001708.9","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1080\/02699052.2022.2105951","article-title":"Early start of thromboprophylaxis does not increase risk of intracranial hematoma progression in multiply injured patients with traumatic brain injury","volume":"36","author":"St\u00f6rmann","year":"2022","journal-title":"Brain Inj"},{"key":"2026010700453528000_10.4.e001708.10","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002830"},{"key":"2026010700453528000_10.4.e001708.11","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1097\/TA.0000000000003475","article-title":"American Association for the Surgery of Trauma\/American College of Surgeons-Committee on Trauma Clinical Protocol for inpatient venous thromboembolism 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Interventions for implementation of thromboprophylaxis in hospitalized patients at risk for venous thromboembolism. 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