Study area and period
The study was conducted in Tibeb Ghion Specialized Hospital (TGSH), Bahir Dar, Ethiopia. Tibeb Ghion Specialized Hospital is one of the largest specialized referral hospitals in the Amhara region and the country at large. It is a specialized public hospital and one of the university hospitals in the country. The hospital is a new referral teaching hospital in the Amhara region, and it is established by Bahir Dar University in 2018 G.C. TGSH, currently runs residency programs in seven specialties. The hospital provides a tertiary level health care service and it is administered by Bahir Dar University. The hospital has more than 500 beds, all over 65 beds are dedicated to Orthopedic Surgery cases. The study was conducted from April 1, 2021 to July 30, 2021.
Study design and population
An institutional based cross sectional study design was applied. The study population was sampled patients with lower extremity trauma who were admitted in the orthopedics department, TGSH from April, 2021 to July, 2021 G.C. and that fulfill the inclusion criteria.
Sample size determination and sampling technique
The sample size was determined using single population proportion formula with the following assumptions: the prevalence of deep vein thrombosis (50%), 95% of the confidence interval, and 5% marginal error and total source population at Tibeb Ghion Specialized Hospital was 400. The final sample size was 196. Systematic sampling technique was used from source population who fulfilled the inclusion criteria.
Data collection tool and procedures
Standard questionnaire adapted from similar articles and modifications based on local resource. The questionnaire was composed of socio-demographic characteristics, Comorbid illness (Hypertension, Heart disease, Diabetes mellitus, Gangrene, Varicose vein, previous history of deep vein thrombosis, HIV/AIDS, Cancer), Associated injury ( Spinal cord injury, Head injury , Vascular injury, Thoracoabdominal injury), Patient behavioral factors (Smoking , Alcohol abuse, Obesity ), Treatment type and Injury related (Injury severity score (ISS), Length of hospital, American society of anesthesiologists (ASA) score), types of injury, and deep vein thrombosis characteristics. Year one orthopedic residents was involved for data collection and one porter assigned to took patients to radiology department for ultrasonography. Supervision of the data collection process was made by the principal investigator. The supervisor crosschecked for completeness and consistency of collected data daily.
Definition of terms and operational definitions
Lower extremity trauma: trauma which includes body of the person from hip to toes.
Deep vein thrombosis: Deep vein thrombosis (DVT) means a blood clot (thrombus) in the deep venous system of the leg. The presence of deep vein thrombosis will be measured using Doppler ultrasound examination if there is visualization of thrombus, absence of flow, lack of compressibility, and lack of augmentations.
Injury severity score (ISS): an established medical score to assess trauma severity. A major trauma is defined as the injury severity score being greater than 15.
Data quality control
Data collection formats was properly designed and data collectors was trained well and supervised by the investigator. Pre-testing was done to ensure that data collectors are clear with the content and techniques of gathering the data. Every datasheet was checked and evaluated by the investigator after collection for its completeness.
Data processing and analysis
Data were coded, entered into and analyzed using SPSS Windows Version 26 for analysis. Descriptive statistics were computed for categorical data and presented by the use of tables, graphs. Continuous variables were summarized using means, median, mode, and standard deviation. Binary logistic regression was applied to see association between exposure variables and deep vein thrombosis. The statically significant association was declared at p-values <0.05.
Ethical clearance was obtained from I ethics review committee of BDU, College of Medicine and Health Sciences. Support letter was obtained from TGSH Confidentiality of patient information was maintained by taking the data anonymously. The data extracted from questioners used for the study and every data kept confidential by securing personal information in passwords. All patients with the diagnosis of DVT were linked to appropriate physicians for medical management.