Abstract
Post-trauma patients are at great risk of pulmonary embolism (PE), however, data assessing specific risk factors for post-traumatic PE are scarce. This was a nested case–control study using the Japan Trauma Data Bank between 2004 and 2017. We enrolled patients aged ≥ 16 years, Injury Severity Score ≥ 9, and length of hospital stay ≥ 2 days, with PE and without PE, using propensity score matching. We conducted logistic regression analyses to examine risk factors for PE. We included 719 patients with PE and 3595 patients without PE. Of these patients, 1864 [43.2%] were male, and their median Interquartile Range (IQR) age was 73 [55–84] years. The major mechanism of injury was blunt (4282 [99.3%]). Median [IQR] Injury Severity Score (ISS) was 10 [9–18]. In the multivariate analysis, the variables spinal injury [odds ratio (OR), 1.40 (1.03–1.89)]; long bone open fracture in upper extremity and lower extremity [OR, 1.51 (1.06–2.15) and OR, 3.69 (2.89–4.71), respectively]; central vein catheter [OR, 2.17 (1.44–3.27)]; and any surgery [OR, 4.48 (3.46–5.81)] were independently associated with PE. Spinal injury, long bone open fracture in extremities, central vein catheter placement, and any surgery were risk factors for post-traumatic PE. Prompt initiation of prophylaxis is needed for patients with such trauma.
Highlights
Pulmonary embolism (PE) poses a great risk of mortality and morbidity for patients after trauma[1,2], among whom prophylaxis for PE is an important consideration
A total of 155,525 patients among the patients who were registered in the Japan Trauma Data Bank (JTDB) database were eligible for this study after inclusion and exclusion criteria
We found no consistent pattern of comorbidities between the two groups (e-Table 1)
Summary
Pulmonary embolism (PE) poses a great risk of mortality and morbidity for patients after trauma[1,2], among whom prophylaxis for PE is an important consideration. Neither could pharmacologic prophylaxis be applied to patients with high risk of bleeding—especially soon after trauma or surgery. It is important to carefully assess risk of PE for each individual patient. Previous studies evaluated the risk of post-traumatic PE. More controversial risk factors of post-traumatic PE are injury sites, blood transfusion, and timing of definitive surgery. Previous studies were not designed to assess specific risk factors for post-traumatic PE, rather investigating the overall outcome of venous thromboembolism (VTE), including deep vein thrombosis (DVT).
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