Factors associated with pulmonary embolism within 72 hours of admission after trauma: a multicenter study.
BACKGROUND
Recent studies using thromboelastography indicate that patients are at risk for hypercoagulability early after injury. Pulmonary embolism (PE) is also well known to cause significant morbidity and mortality after injury and can occur within 72 hours of admission (early PE). Despite this risk, prophylactic anticoagulation is often delayed in patients with certain injuries due to concerns about bleeding.


METHODS
This was a retrospective study of injured patients with a PE from 2007 to 2013 at 3 level I trauma centers. Data collected included patient demographics, injury patterns, length of stay, timing of prophylaxis for deep vein thrombosis (DVT), and diagnosis of PE. Patients with early PE (≤ 3 days) were compared with those with late PE (>3 days) using bivariate and multivariable analysis.


RESULTS
A total of 54,964 patients were admitted to the 3 centers during the study period, and 144 (0.26%) were diagnosed with a PE. Eleven were excluded from the study due to a lack of critical data, leaving 133 patients (43% early PE). Factors associated with early PE included long bone fractures in the lower extremity and an Abbreviated Injury Score (AIS) Extremity ≥ 3. Higher Injury Severity Score, severe chest and head trauma (AIS ≥ 3), and not receiving DVT prophylaxis within 48 hours of hospital admission were not associated with early PE.


CONCLUSIONS
Early PE is a significant clinical entity occurring in nearly half the patients who suffered a PE. Early PE is associated with long bone fractures and severe extremity trauma, but not severe thoracic injury. Timing of prophylactic anticoagulation had no impact on early PE. If further studies confirm this incidence of unsuspected early PE, all admitted trauma patients should be assessed for a hypercoagulable state after injury.
Department of Surgery, Indiana University, Indianapolis, IN. Electronic address: jcoleman6@iuhealth.org.
Jamie J
JJ
Coleman
Department of Surgery, Indiana University, Indianapolis, IN.
Ben L
BL
Zarzaur
Department of Surgery, Indiana University, Indianapolis, IN.
Chad W
CW
Katona
Department of Surgery, Indiana University, Indianapolis, IN.
Zachary J
ZJ
Plummer
Department of Surgery, MedStar Washington Hospital Center, Washington, DC.
Laura S
LS
Johnson
Department of Surgery, Indiana University, Indianapolis, IN.
Alison
A
Fecher
Department of Surgery, Indiana University, Indianapolis, IN.
Jamie M
JM
O'Rear
Department of Surgery, Indiana University, Indianapolis, IN.
David V
DV
Feliciano
Department of Surgery, Indiana University, Indianapolis, IN.
Grace S
GS
Rozycki
D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010343:Patient Admission / Q000706:statistics & numerical data*; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013916:Thrombelastography; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D014947:Wounds and Injuries / Q000150:complications* / Q000175:diagnosis