In severely injured trauma patients, higher hospital use of inferior vena cava filters did not improve survival and was linked to more thromboembolic events.

• Among 2.28 million patients at 427 level I and II trauma centers, 0.81% received a filter.
• Use fell from 1.15% in 2017 to 0.59% in 2024, but rates ranged from 0% to 11.5%; 22.5% of centers were high utilizers (≥1%).
• Higher use was not associated with mortality (correlation 0.01; P=.77), but correlated with deep vein thrombosis, pulmonary embolism, and venous thromboembolism.

The findings support center-level review and adherence to guideline-based indications: proximal thrombosis or embolism with a contraindication to anticoagulation.