Risk Factors for Lower Extremity Deep Vein Thrombosis by Spinal Cord Injury Level: A Population-Based Analysis

Study Design A retrospective database analysis. Objective To determine the incidence of lower extremity deep vein thrombosis (DVT) and identify risk factors associated with DVT development in patients with spinal cord injury (SCI), stratified by level of injury. Methods The National Inpatient Sample from 2016 to 2021 was used to identify adult inpatients with SCI who developed DVT within the same admission and to categorize them by anatomical injury level. Multivariable logistic regression was used to assess independent risk factors by SCI level. Results Among 59,498 SCI patients, the overall DVT incidence was 2.8%. The DVT rate was lowest in cervical SCI (2.6%) and highest in thoracic SCI (3.2%). Pulmonary embolism was a strong independent risk factor for DVT across all SCI levels ([Cervical] OR: 12.82, CI: 10.46-15.63, [Thoracic] OR: 11.82, CI: 9.13-15.20, [Lumbar] OR: 11.38, CI: 6.74-18.74). For cervical SCI, risk factors included coagulopathies (OR: 1.90, CI: 1.54-2.32), older age (OR: 1.01, CI: 1.01-1.02), complete (OR: 1.84, CI: 1.43-2.35) or incomplete cervical lesion (OR: 1.38, CI: 1.17-1.63), cervical (OR: 1.34, CI: 1.16-1.54) or lumbar fracture (OR: 1.58, CI: 1.17-2.11), and upper extremity DVT (OR: 3.58, CI: 2.53-4.97). For thoracic SCI, risk factors included thoracic fracture (OR: 1.46, CI: 1.20-1.77), upper extremity DVT (OR: 3.82, CI: 2.18-6.36), and fluid/electrolyte disorder (OR: 1.35, CI: 1.13-1.62). For lumbar SCI, fluid/electrolyte disorder (OR: 1.92, CI: 1.38-2.66) was an independent predictor. Conclusion DVT incidence and risk factors vary by SCI level. Identifying these factors is critical for stratifying care and developing tailored prophylactic strategies that prevent adverse events and optimize patient outcomes.