Early Versus Late Pulmonary Embolism in Trauma Patients: Not All Pulmonary Embolisms are Created Similarly

Gambhir, Sahil; Grigorian, Areg; Ashbaugh, Alyssa G.; Spencer, Dean; Ramakrishnan, Divya; Schubl, Sebastian; Dolich, Matthew; Nahmias, Jeffry

doi:10.1016/j.jss.2019.02.018

Cited by 8 publications

(9 citation statements)

References 18 publications

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“…However, no significant difference was observed for the need of blood transfusion and MT among the two groups in our study. Gambhir et al 17 reported that above knee DVT and blood transfusion were significant risk factors for late PE while smoking history was significant in early PE. According to published reports, fatality rates from trauma-related PE range from 17% to 26%.…”

Section: Discussionmentioning

confidence: 99%

“…Late PE referred to cases diagnosed after 4 days of hospitalization, based on previous publications. 14 , 16 , 17 …”

Section: Methodsmentioning

confidence: 99%

“…[13][14][15] Previous studies have demonstrated that up to half of PEs occur within the first 4 days of hospitalization. 14,16,17 It was found that early PE is associated with a significantly higher risk of early mortality as opposed to late PE. 18 Of note, the occurrence of early PE can be predicted in trauma patients requiring ICU admission, particularly in older age, patients with long bone fractures and those with severe injury.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Characteristics and Risk Factors for Early versus Late Pulmonary Embolism in Trauma Patients: A Retrospective, Observational Study

Siddiqui¹,

Asim²,

Ahmed³

et al. 2022

IJGM

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Background We sought to evaluate the clinical characteristics and risk factors for early versus late pulmonary embolism (PE) in trauma patients. Methods This was a retrospective analysis of injured patients who presented with a confirmed PE between 2013 and 2019. Data were analysed and compared for patients with early PE (≤4 days) versus late PE (>4 days post-trauma). Results The study included 82 consecutive trauma patients with confirmed diagnosis of PE. The mean age of patients was 42.3 ± 16.2 years. The majority were males (79.3%) and the median time from injury to PE was 10 days. Of the PE cases, 24 (29.3%) had early PE, while 58 (70.7%) had late PE. The early PE group had higher rates of surgical intervention within 24 hours of admission than the late PE group (p = 0.001). Also, the rate of sub-segmental thrombi was significantly higher in the early PE group (p = 0.01). The late PE group sustained more moderate-to-severe injuries ie, GCS ED <13 (p = 0.03) and the median time from injury to PE diagnosis was 15 days (p = 0.001). After adjusting for the potential covariates, surgery within 24 hours of admission [adjusted odds ratio 37.58 (95% confidence interval 3.393–416.20), p = 0.003] was found to be significant independent predictor of early PE in trauma patients. Conclusion One-third of post-trauma PEs occurs early after trauma and the surgical intervention within the first 24 hours of admission is a major risk factor. A prospective study is needed to develop an objective risk assessment for the prevention and detection of early and late PE post-trauma.

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Section: Discussionmentioning

confidence: 99%

“…Late PE referred to cases diagnosed after 4 days of hospitalization, based on previous publications. 14 , 16 , 17 …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Characteristics and Risk Factors for Early versus Late Pulmonary Embolism in Trauma Patients: A Retrospective, Observational Study

Siddiqui¹,

Asim²,

Ahmed³

et al. 2022

IJGM

View full text Add to dashboard Cite

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“…Smoking is associated with an increased incidence of PE 29 . A previous study showed that a history of smoking was the only risk factor for early PE in patients with trauma 30 . Smoking can increase the levels of fibrinogen and tissue factor, aggravate blood viscosity, and eventually lead to a prethrombotic state 31 .…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Outcomes for Preoperative Asymptomatic Pulmonary Embolism in Patients Aged 60 Years and Over with Hip Fracture

Zhou

Wang

Dai

et al. 2021

Orthopaedic Surgery

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Objective To investigate the risk factors for, and outcomes of, preoperative asymptomatic pulmonary embolism (PE) in patients ≥60 years old following delayed operation for hip fracture. Methods From March 2017 to December 2018, 90 patients aged ≥60 years with hip fracture who suffered a delay in surgery were recruited to this prospective study following admission to our hospital. Computed tomography pulmonary angiography (CTPA) was used to detect preoperative asymptomatic PE and calculated its incidence. Time from injury to admission, baseline characteristics, medical comorbidities, and blood biomarker levels were evaluated as potential risk factors. Logistic regression analysis was used to identify risk factors. Mortality and major bleeding events were recorded and compared between individuals with PE and without. Data were analyzed by t‐test, Mann–Whitney U test, χ2 test, Fisher's exact test, and logistic regression analysis. Results The incidence of preoperative asymptomatic PE was 18.9% (17/90 patients). In the univariate analysis, the risk factors for preoperative asymptomatic PE were male sex, hypertension, cerebrovascular accident, smoking, plasma D‐dimer level, potassium level, urea level, creatinine level, and cysteine level. Multivariate logistic regression analysis showed that the risk of preoperative asymptomatic PE was higher in patients with hypertension (odds ratio [OR] = 10.048; 95% confidence interval [CI], 1.118–90.333), cerebrovascular accident (OR = 20.135; 95% CI, 1.875–216.164), smoking (OR = 48.741; 95% CI, 4.155–571.788), high plasma D‐dimer levels (OR = 1.200; 95% CI, 1.062–157.300), and high plasma potassium levels (OR = 12.928; 95% CI, 1.062–157.300). All patients were followed up for 21.0 months (range, 2 to 36 months). Mortality within the first year postoperatively was higher in patients with PE (29.41% vs 9.59%, P = 0.046). Conclusions In view of the high incidence of preoperative asymptomatic PE and the inferior prognosis in individuals with PE, routine CTPA examination for preoperative asymptomatic PE could be useful for patients aged ≥60 years with hip fracture for whom surgery is delayed.

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“…Compared with this study, previous studies were limited by small sample size and uncontrolled potential confounders such as comorbidities, severity, and surgery. Regarding head trauma, recent studies focusing on the timing of post-traumatic PE showed that head trauma was associated with late onset of PE 16 , 36 – 38 . Our cohort might have captured only early PE.…”

Section: Discussionmentioning

confidence: 99%

A nested case–control study of risk for pulmonary embolism in the general trauma population using nationwide trauma registry data in Japan

Iriyama

Komori

Kainoh

et al. 2021

Sci Rep

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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.

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Early Versus Late Pulmonary Embolism in Trauma Patients: Not All Pulmonary Embolisms are Created Similarly

Cited by 8 publications

References 18 publications

Clinical Characteristics and Risk Factors for Early versus Late Pulmonary Embolism in Trauma Patients: A Retrospective, Observational Study

Clinical Characteristics and Risk Factors for Early versus Late Pulmonary Embolism in Trauma Patients: A Retrospective, Observational Study

Risk Factors and Outcomes for Preoperative Asymptomatic Pulmonary Embolism in Patients Aged 60 Years and Over with Hip Fracture

A nested case–control study of risk for pulmonary embolism in the general trauma population using nationwide trauma registry data in Japan

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