Incidence of asymptomatic pulmonary embolism in moderately to severely injured trauma patients.
BACKGROUND
Chest computed tomographic (CT) scanning is used frequently to evaluate symptomatic patients for pulmonary embolus (PE). The incidence of PE diagnosed by helical CT scanning in asymptomatic patients is unknown.


METHODS
Asymptomatic trauma patients with an Injury Severity Score > or = 9 were studied with contrast-enhanced helical CT images of the chest, pelvis, and lower extremities. Clot burden was assessed using an anatomic scoring system. Patients not receiving anticoagulation were followed.


RESULTS
Twenty-two of 90 patients had a PE. Four had major clot burden, including one patient with a saddle embolus. Risk factors for asymptomatic PE include age (odds ratio [OR], 1.04), head injury (OR, 6.78), chest injury (OR, 4.51), lower extremity injury (OR, 5.03), and transfusion (OR, 3.42). Thirty percent of patients receiving pharmacologic prophylaxis had a PE.


CONCLUSIONS
Asymptomatic PE occur in 24% of moderately to severely injured patients. Age, head, chest, and lower extremity injury are associated with an increased risk. Standard thromboembolic prophylaxis is not reliably protective.
Schultz
David J
DJ
Department of Surgery Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Brasel
Karen J
KJ
Washington
Lacey
L
Goodman
Lawrence R
LR
Quickel
Robert R
RR
Lipchik
Randolph J
RJ
Clever
Todd
T
Weigelt
John
J
D000328:Adult; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D036542:Tomography, Spiral Computed; D014947:Wounds and Injuries / Q000145:classification / Q000150:complications*