title: Treatment and complications in orthopaedic trauma patients with symptomatic pulmonary embolism.
abstract: OBJECTIVE
  The purpose of this study is to characterize the presentation, size, treatment, and complications of pulmonary embolism (PE) in a large series of orthopaedic trauma patients who developed PE after injury.
  
  
  METHODS
  We reviewed the records of orthopaedic trauma patients who developed a PE within 6 months of injury at 9 trauma centers and 2 tertiary care facilities.
  
  
  RESULTS
  There were 312 patients, 186 men and 126 women, average age 58 years. Average body mass index was 29.6, and average Injury Severity Score was 18. Seventeen percent received anticoagulation before injury, and 5% had a history of PE. After injury, 87% were placed on prophylactic anticoagulation and 68% with low-molecular weight heparin. Fifty-three percent of patients exhibited shortness of breath or chest pain. Average heart rate and O2 saturation before PE diagnosis were 110 and 94%, respectively. Thirty-nine percent had abnormal arterial blood gas, and 30% had abnormal electrocardiogram findings. Eighty-nine percent had computed tomography pulmonary angiography for diagnosis. Most clots were segmental (63%), followed by subsegmental (21%), lobar (9%), and central (7%). The most common treatment was unfractionated heparin and Coumadin (25%). Complications of anticoagulation were common: 10% had bleeding at the surgical site. Other complications of anticoagulation included gastrointestinal bleed, anemia, wound complications, death, and compartment syndrome. PE recurred in 1% of patients. Four percent died of PE within 6 months.
  
  
  CONCLUSIONS
  This is the first large data set to evaluate the course of PE in an orthopaedic trauma population. The complications of anticoagulation are significant and were as common in patients with lower risk clots as those with higher risk clots.
authors.affiliation: *Boston Medical Center, Boston, MA; †Dalhousie University, Nova Scotia, Canada; ‡Tampa General Hospital, Tampa, FL; §London Health Science Center, Ontario, Canada; ‖University of Massachusetts, Boston, MA; ¶Indiana University-Purdue, Indianapolis, IN; **MetroHealth Medical Center, Cleveland, OH; ††HCMC, Minneapolis, MN; ‡‡NYU Hospital for Joint Diseases, New York, NY; §§Stony Brook University Health Sciences Center, Stony Brook, NY; and ‖‖Texas Health Fort Worth, Fort Worth, TX.
authors.forename: Yelena
authors.initials: Y
authors.lastname: Bogdan
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
authors.forename: Ross
authors.initials: R
authors.lastname: Leighton
authors.forename: Uwe
authors.initials: U
authors.lastname: Dahn
authors.forename: Henry
authors.initials: H
authors.lastname: Sagi
authors.forename: Charles
authors.initials: C
authors.lastname: Nalley
authors.forename: David
authors.initials: D
authors.lastname: Sanders
authors.forename: Jodi
authors.initials: J
authors.lastname: Siegel
authors.forename: Brian
authors.initials: B
authors.lastname: Mullis
authors.forename: Thomas
authors.initials: T
authors.lastname: Bemenderfer
authors.forename: Heather
authors.initials: H
authors.lastname: Vallier
authors.forename: Alysse
authors.initials: A
authors.lastname: Boyd
authors.forename: Andrew
authors.initials: A
authors.lastname: Schmidt
authors.forename: J R
authors.initials: JR
authors.lastname: Westberg
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Egol
authors.forename: Stephen
authors.initials: S
authors.lastname: Kottmeier
authors.forename: Cory
authors.initials: C
authors.lastname: Collinge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000925:Anticoagulants