Incidence and risk factors for fatal pulmonary embolism after major trauma: a nested cohort study

Abstract

Fatal PE appeared to be a potential preventable cause of late mortality after major trauma. Severity of injuries, co-morbidity, and BMI were important risk factors for fatal PE after major trauma.

Use of Prophylactic Inferior Vena Cava Filters in Trauma

“…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. 8 Several studies have attempted to identify risk factors for VTEs following trauma.…”

Detailed assessment of benefits and risks of retrievable inferior vena cava filters on patients with complicated injuries: the da Vinci multicentre randomised controlled trial study protocol

“…Our recent study did, however, suggest that fatal PE is a preventable disease, with an attributable mortality of 50% (95% CI 36% to 62%), and it accounts for about 12% of all deaths after major trauma. 54 55 Furthermore, our recent multicentre observational studies showed that acute PE is a major cause of morbidity and mortality in critically ill patients, 56 and omission of early VTE prophylaxis in critically ill patients, in particular after multiple trauma, either without clinical reasons (relative risk of 1.66, 95% CI 1.22 to 2.25; absolute increase in risk 3.9%, 95% CI 2.2 to 5.6) or due to contraindications from increased bleeding risk, is associated with a substantial increased risk of mortality. 18 Retrievable IVC filters have been used in our patients with trauma in Western Australia (WA) since 2007, and in the years 2007 and 2008, 7.4% of all patients with trauma received a retrievable IVC filter.…”

“…The use of IVC filters was still associated with substantial risks of lower or upper limb VTE (16%) and mechanical complications (12%) including adherent filter (5%) and IVC filter occlusion due to thrombus (4%), despite a high filter retrieval rate (87%) through a centralised protocol and process. 42 Evidence suggested that if IVC filters are applied to all patients with major trauma, the estimated number of IVC filters needed to prevent one fatal PE is relatively large (mean 125, 95% CI 100 to 167) 54 and may not be cost-effective.…”

“…54 According to the Trauma Embolic Scoring System (TESS) (see online supplementary appendix 2), 57 58 the TESS score for this type of patients would be likely greater than 10 with an estimate risk of symptomatic VTE between 10% and 20% even when a proactive approach to detect VTE is not adopted. Even though many patients with major trauma will have deranged coagulation profiles which are considered as contraindicated to receive anticoagulant prophylaxis, their propensity to develop VTE does not appear to be different from those without such acquired coagulopathy.…”

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

“…Mortality rates have been reported to range between 0.38% and 13.8% [10,11]. Principal risk factors include an injury severity score (ISS) greater than 50 and more than two surgical procedures [9].…”