A cohort study on the incidence and outcome of pulmonary embolism in trauma and orthopedic patients

Abstract

Background: This study aims to determine the incidence of pulmonary embolism (PE) in trauma and orthopedic patients within a regional tertiary referral center and its association with the pattern of injury, type of treatment, co-morbidities, thromboprophylaxis and mortality. Methods: All patients admitted to our institution between January 2010 and December 2011, for acute trauma or elective orthopedic procedures, were eligible to participate in this study. Our cohort was formed by identifying all patients with clinical features of PE who underwent Computed Tomography-Pulmonary Angiogram (CT-PA) to confirm or exclude the clinical suspicion of PE, within six months after the injury or the surgical procedure. Case notes and electronic databases were reviewed retrospectively to identify each patient's venous thromboembolism (VTE) risk factors, type of treatment, thromboprophylaxis and mortality.

Use of Prophylactic Inferior Vena Cava Filters in Trauma

“…Permanent filters are designed to function indefinitely while non-permanent filters are subdivided into temporary filters which must be removed or retrievable filters that can either be removed or left in place as a permanent implant, depending on the patient's clinical condition. 6 Since the introduction of percutaneously-inserted IVC filters approximately 30 years ago, there has been extensive development of filter designs aiming to improve success rates and lower complication rates.…”

“…A cohort study from the UK of acute trauma patients admitted between 2010-2011 found the incidence of PE to be 0.8%; most of these patients had lower limb fractures. 6 Ho et al found that fatal PEs accounted for 11.9% of all deaths among 971 consecutive trauma patients. 7 One reason for the variability in reported VTE incidences could be differences in the techniques used to confirm or diagnose the condition, while another explanation could be under-reporting, perhaps due to a reluctance to perform autopsies in cases of sudden death.…”

Reduction in Venous Thromboembolism Events: Trauma Performance Improvement and Loop Closure Through Participation in a State-Wide Quality Collaborative

“…The methodology used to screen and diagnose trauma patients with VTE events varies among trauma centers. 2,[18][19][20][21] The University of Michigan trauma service VTE assessment protocol is focused on obtaining studies in symptomatic patients. If we clinically suspect a pulmonary embolus, a CT pulmonary angiogram and/ or extremity deep venous thrombosis scan is obtained.…”

Rehabilitation of Lower Extremity Trauma: a Review of Principles and Military Perspective on Future Directions

“…In a cohort study of 18,151 orthopedic and trauma patients, Gudipati et al [66] found that PE still developed in these patients despite mechanical and chemical thromboprophylaxis, implicating the importance of optimizing other modifiable risk factors. Even restricted weight bearing may be beneficial for VTE prevention, as venous return is not diminished in partial weight bearing when compared to full weight bearing [67].…”

“…Orthopedic trauma has a relatively high incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) [64], with risk increased by injury severity score (ISS) >50, greater than two surgeries, a history of venous thromboembolism (VTE), comorbidities, traumatic brain injury, prolonged hospitalization, and reduced mobility [64][65][66]. In a cohort study of 18,151 orthopedic and trauma patients, Gudipati et al [66] found that PE still developed in these patients despite mechanical and chemical thromboprophylaxis, implicating the importance of optimizing other modifiable risk factors.…”