title: Pulmonary emboli after blunt trauma: timing, clinical characteristics and natural history.
abstract: BACKGROUND
  Venous thromboembolism (VTE) frequently complicates the recovery of trauma patients, and contributes to morbidity and mortality. Recent studies showed an increase in diagnosis of pulmonary embolism (PE) mainly in the early or immediate period after trauma. The clinical significance of those incidental PEs is unclear.
  
  
  METHODS
  The study cohort included all blunt trauma patients who had a contrast-enhanced CT of the chest performed as part of their initial trauma assessment from January 1, 2005 to January 31, 2007 in a large academic Canadian trauma centre. Patients diagnosed with PE at any point during admission were identified using our institutional trauma registry. All chest CT scans and electronic charts were reviewed. Patients were classified according to time of PE detection (immediate, early or late) and symptoms (asymptomatic or symptomatic). The clinical characteristics and hospital course of the patients who were diagnosed with immediate PE were described.
  
  
  RESULTS
  1259 blunt trauma patients were reviewed. Six patients presented with immediate PE (0.5%); nine patients were found to have early PE (0.7%) and 13 had late PE (1.0%). All six of the patients with immediate PE were classified as asymptomatic. Five of the nine patients with early PE were symptomatic and all 13 patients who developed late PE were symptomatic. Amongst the six patients with immediate PE, five survived 24h hospitalisation. Four of them were managed with prophylactic low molecular weight heparin and no other thromboembolic events were observed during admission or after discharge.
  
  
  CONCLUSIONS
  The increased use of advanced CT technology in trauma patients has resulted in an increased diagnosis of incidental PEs that are asymptomatic. The clinical significance and management of these small, incidental PE are uncertain and further studies are needed to clarify the natural history of this controversial finding.
authors: Trauma Program, Department of Surgery of Sunnybrook Health Sciences Centre, University of Toronto, Canada. Fernando.Spencer@uhn.on.ca
authors: Fernando
authors: F
authors: Spencer Netto
authors: Homer
authors: H
authors: Tien
authors: Jeremy
authors: J
authors: Ng
authors: Sarah
authors: S
authors: Ortega
authors: Sandro
authors: S
authors: Scarpelini
authors: Sandro B
authors: SB
authors: Rizoli
authors: William
authors: W
authors: Geerts
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging* / Q000453:epidemiology
chemical_list: D000925:Anticoagulants