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August 1997

Timing of the Occurrence of Pulmonary Embolism in Trauma Patients

Author Affiliations

From the Department of Surgery, University of California, Davis, Medical Center, Sacramento.

Arch Surg. 1997;132(8):862-867. doi:10.1001/archsurg.1997.01430320064010

Objective:  To determine how soon after trauma pulmonary embolism (PE) occurs and if there is an association between the duration of this interval and mortality.

Design:  Retrospective case series.

Patients:  All patients admitted to our trauma service with established PE based on high probability findings on ventilation perfusion scan, positive results on a pulmonary arteriogram, or autopsy from July 1, 1990, to September 30, 1995.

Main Outcome Measure:  Time interval between injury and PE.

Setting:  Level I university trauma center.

Results:  Of 18 255 trauma patients identified, 63 met our criteria for PE (30 using a pulmonary arteriogram; 26, a ventilation perfusion scan; and 7, autopsy). Four patients (6%) had a documented PE on day 1 following injury. Mortality was not correlated with the interval between injury and PE. Of the 63 patients, 58 (92%) had 1 or more established risk factors for thromboembolism. The ratio of PaO2 to fraction of inspired oxygen was the only factor predictive of mortality (P=.02, logistic regression analysis).

Conclusions:  Pulmonary embolism occurs in the immediate period following injury. Aggressive workup in patients with signs consistent with PE should be instituted promptly. Trauma patients who have at least 1 risk factor for thromboembolism should receive prophylaxis as soon after injury as possible.Arch Surg. 1997;132:862-867