Factors Associated with Pulmonary Embolism Within 72 Hours of Admission after Trauma: A Multicenter Study - 23/03/15

Doi : 10.1016/j.jamcollsurg.2014.12.032

Jamie J. Coleman, MD ^a,^⁎ , Ben L. Zarzaur, MD, MPH, FACS ^a, Chad W. Katona, MD ^a, Zachary J. Plummer, BS ^a, Laura S. Johnson, MD, FACS ^b, Alison Fecher, MD, FACS ^a, Jamie M. O’Rear, BS ^a, David V. Feliciano, MD, FACS ^a, Grace S. Rozycki, MD, MBA, FACS ^a
^a Department of Surgery, Indiana University, Indianapolis, IN
^b Department of Surgery, MedStar Washington Hospital Center, Washington, DC

^∗Correspondence address: Jamie J Coleman, MD, IU Health Methodist Hospital, 1604 Capitol Avenue, Suite B242, Indianapolis, IN. 46202.

Abstract

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.

Study Design

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.

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Abbreviations and Acronyms : AIS, DVT, IQR, ISS, PE

Plan

	Disclosure Information: Nothing to disclose.
	Disclosures outside of the scope of this work: Dr Johnson received a grant from ABA Rescue Trial and payment for the JMS Burn Symposium in 2014; Dr Feliciano received payment from the Indiana School of Medicine for speaking, and royalties from McGraw Hill; and Dr Fecher received payment as a consultant for Livecell and was paid for expert testimony for the Indiana Panel Review.