Risk factors associated with pulmonary embolism despite routine prophylaxis: implications for improved protection.
Despite prophylaxis, pulmonary embolism (PE) remains a major cause of posttraumatic morbidity and mortality in high-risk patients. We studied injury-related risk factors associated with the occurrence of PE despite routine prophylaxis. A review of 9721 trauma patients discharged from January 1, 1985 through December 31, 1992, identified 36 patients (0.4%) who suffered clinically evident PE despite a policy of routine prophylaxis against deep venous thrombosis that included use of prophylactic inferior vena caval filters. (Twenty-nine patients had an inferior vena caval filter placed for prophylaxis against PE.) A detailed analysis of injury-related risk factors was performed. Four high-risk patterns of injury were identified, representing common combinations of significant risk factors. These patient groups have an absolute risk of PE despite prophylaxis ranging from 1.5% to 3.8%. The relative risk is approximately ten times that of control patients. Identification of appropriate high-risk groups is necessary to allow optimization of prophylactic measures, including placement of inferior vena caval filter.
Winchell
R J
RJ
Department of Surgery, University of California, San Diego.
Hoyt
D B
DB
Walsh
J C
JC
Simons
R K
RK
Eastman
A B
AB
D000328:Adult; D005163:Factor Analysis, Statistical; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000150:complications