A cross-sectional study of the use of graduated compression stockings at two top end hospitals in Darwin, Australia.

Abstract

Background: Venous thromboembolism (VTE) is the main cause of hospital-acquired adverse events globally, affecting approximately 10 million people annually. Methods of VTE prophylaxis include anticoagulants and/or mechanical prophylaxis, such as graduated compression stockings (GCS). Objective: This study aimed to determine whether (a) GCS are used appropriately for VTE prophylaxis and (b) GCS are fitted correctly or cause adverse events. Methods: A cross-sectional study of adults aged >18 years admitted to acute wards of two Darwin public hospitals was undertaken in May 2024. Medical records were examined to identify if GCS were prescribed and if any contraindications to GCS were present. Participants who were wearing or had worn GCS within the last 24 hours were assessed for GCS usage, prescription of GCS, the presence of contraindications to GCS, correct fitting of GCS, and the presence of adverse events. Results: Of 398 admitted participants, GCS were prescribed in 49 (13%) and GCS were being used in 77 (19%). A total of 46 (12%) participants consented to assessment of GCS fit. Thirteen participants had contraindications for GCS use, 6 (13%) potential and 7 (15%) absolute, with 4 (31%) having adverse events associated with GCS use. Measurements of the knee, calf, and ankle found that only 6 (14%) of 43 participants were wearing GCS that fitted correctly according to the manufacturer's recommendations, and leg measurements were not taken in 20 (44%) participants before GCS application. There were a wide variety of foot sizes in participants wearing each of the different sized GCS, with reduced correlation between foot width and knee (ρ = 0.26) or calf circumference (ρ = 0.27). Conclusions: The current study found reduced compliance with measures designed to enable correct GCS fitting at each stage of the fitting cascade. Foot sizes varied with other leg measurements, suggesting a greater need for personalized fitting approaches. There is a need for a systematic approach to education and fitting of GCS in health care services to ensure their correct and safe fitting.