A Cross-Sectional Study of the use of Graduated Compression Stockings (GCS) at two Top End Hospitals in Darwin, Australia

BACKGROUND: Methods of VTE prophylaxis include anticoagulants and/or mechanical prophylaxis, such as Graduated Compression Stockings (GCS). OBJECTIVES: 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 >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, presence of contraindications to GCS, correct fitting of GCS and presence of adverse events. RESULTS: Of 398 admitted participants, GCS were prescribed in 49 (13%) and GCS were being used in 77 (19%). 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 only 6 (14%) of 43 participants were wearing GCS that fitted correctly according to manufacturer's recommendations, and leg measurements were not taken in 20 (44%) participants prior to 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). CONCLUSION: 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 personalised fitting approaches. There is a need for a systematic approach to education and fitting of GCS in healthcare services to ensure their correct and safe fitting.