Trauma-induced pulmonary thromboembolism: What's update?

Mi, Yuhong; Ming-ying, XU

doi:10.1016/j.cjtee.2021.08.003

Cited by 16 publications

(9 citation statements)

References 124 publications

(136 reference statements)

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“…Notably, in-hospital complications can occur within the initial 48-72 h post-trauma, and thus, patients hospitalized for >24 h may still have the potential for substantial active hemorrhage and thrombophilic disorders. 4,25 This is the rationale for considering deaths within 48 h as early mortality in our study.…”

Section: Discussionmentioning

confidence: 99%

Time and Risk Factors of Trauma-Related Mortality: A 5-Year Retrospective Analysis From a National Level I Trauma Center

Asim,

El-Menyar,

Abdelrahman

et al. 2024

J Intensive Care Med

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Background: We aimed to analyze in-hospital timing and risk factors for mortality in a level 1 trauma center. Methods: This is a retrospective analysis of all trauma-related mortality between 2013 and 2018. Patients were divided and analyzed based on the time of mortality (early (≤48 h) vs late (>48 h)), and within different age groups. Multivariate regression analysis was performed to predict in-hospital mortality. Results: 8624 trauma admissions and 677 trauma-related deaths occurred (47.7% at the scene and 52.3% in-hospital). Among in-hospital mortality, the majority were males, with a mean age of 35.8 ± 17.2 years. Most deaths occurred within 3–7 days (35%), followed by 33% after 1 week, 20% on the first day, and 12% on the second day of admission. Patients with early mortality were more likely to have a lower Glasgow coma scale, a higher shock index, a higher chest and abdominal abbreviated injury score, and frequently required exploratory laparotomy and massive blood transfusion ( P < .005). The injury severity scores and proportions of head injuries were higher in the late mortality group than in the early group. The severity of injuries, blood transfusion, in-hospital complications, and length of intensive care unit stay were comparable among the age groups, whereas mortality was higher in the age group of 19 to 44. The higher proportions of early and late in-hospital deaths were evident in the age group of 24 to 29. In multivariate analysis, the shock index (OR 2.26; 95%CI 1.04-4.925; P = .04) was an independent predictor of early death, whereas head injury was a predictor of late death (OR 4.54; 95%CI 1.92-11.11; P = .001). Conclusion: One-third of trauma-related mortalities occur early after injury. The initial shock index appears to be a reliable hemodynamic indicator for predicting early mortality. Therefore, timely hemostatic resuscitation and appropriate interventions for bleeding control may prevent early mortality.

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Section: Discussionmentioning

confidence: 99%

Time and Risk Factors of Trauma-Related Mortality: A 5-Year Retrospective Analysis From a National Level I Trauma Center

Asim,

El-Menyar,

Abdelrahman

et al. 2024

J Intensive Care Med

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“…According to other studies, this incidence rate could rise to as high as 30% in ICU-admitted patients [ 11 , 12 ]. Pulmonary-related complications were the most frequent posttrauma complications, while thromboembolic events were associated with the highest mortality rate [ 11 , 20 , 22 ]. Notably, patients with more complications and/or with major complications were at greater risk for death.…”

Section: Discussionmentioning

confidence: 99%

Frequency of posttrauma complications during hospital admission and their association with Injury Severity Score

Dasdar,

Yousefifard,

Ranjbar

et al. 2023

Clin Exp Emerg Med

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Objective Multiple trauma is associated with a remarkable risk of in-hospital complications, which harm healthcare services and patients. This study aimed to assess the incidence of posttrauma complications, their relationship with poor outcomes, and the effect of the Injury Severity Score (ISS) on their occurrence.Methods This retrospective cohort study was conducted at a pair of trauma centers, between January 2020 and December 2022. All hospitalized adult patients with multiple trauma were included in this study. Multivariable logistic regression was used to identify factors related to posttrauma complications.Results Among 727 multiple trauma patients, 90 (12.4%) developed in-hospital complications. The most frequent complications were pneumonia (4.8%), atelectasis (3.7%), and superficial surgical site infection (2.5%). According to multivariable logistic regression, ISS, the length of stay in the intensive care unit (ICU), the length of stay in the hospital, and mortality were significantly associated with complications. The complication rate increased by 17% with every single-unit increase in ISS (adjusted odds ratio [OR], 1.17; 95% confidence interval [CI], 1.00–1.38). Per every 1-day increase in the ICU or hospital stay, the complication rate increased by 65% (adjusted OR, 1.65; 95% CI, 1.00–2.73) and 20% (adjusted OR, 1.20; 95% CI, 1.03–1.41), respectively. Posttrauma complications were also significantly more common in patients with mortality (adjusted OR, 163.30; 95% CI, 3.04–8,779.32). In multiple trauma patients with a higher ISS, the frequency, severity, and number of complications were significantly increased.Conclusion In-hospital complications in multiple trauma patients are frequent and associated with poor outcomes and mortality. ISS is an important factor associated with posttrauma complications.

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“…The literature suggests that early PE is considered if occurs within 3 to 4 days after injury, this could be explained by how early the dual regulation of inflammation and thrombosis in the post-trauma period is. 24 , 26 The occurrence of PE in trauma patients within 72 h represented 41.5% of the total VTE. 24 Therefore, the present study considered early PE to occur within 4 days of hospitalization; based on this, 29% of our post-trauma PE patients developed early PE, and 71% had late PE.…”

Section: Discussionmentioning

confidence: 99%

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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Trauma-induced pulmonary thromboembolism: What's update?

Cited by 16 publications

References 124 publications

Time and Risk Factors of Trauma-Related Mortality: A 5-Year Retrospective Analysis From a National Level I Trauma Center

Time and Risk Factors of Trauma-Related Mortality: A 5-Year Retrospective Analysis From a National Level I Trauma Center

Frequency of posttrauma complications during hospital admission and their association with Injury Severity Score

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

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