T. S. Hester1, J. C. Allmon1, J. H. Habib1, J. W. Dennis1 1University Of Florida,Surgery,Jacksonville, FL, USA
Introduction:
Venous thromboembolic (VTE) events are a major contributor to the morbidity and mortality of the severely injured trauma patient. Despite aggressive prophylaxis there is still a number of trauma patients diagnosed with pulmonary embolism. The purpose of this study was to better characterize the incidence, etiology, and distribution of VTE in multi-system trauma patients to promote a more specific directed treatment and improve prophylactic measures.
Methods:
The trauma registry at a level I trauma center was utilized to collect data retrospectively on all trauma patients with a diagnosis of PE over a 14 year period. Age, sex, ISS, injuries, operations, DVT prophylaxis, IVC filter placement, specific CTA findings of PE, septic episodes and blood products administered were recorded.
Results:
A total of 77 patients had a diagnosis of ‘PE’, but 12 had incomplete data or previous underlying diseases that affected their VTE risk. The remaining 65 patients were placed into the four categories: Group 1: 29 patients (45%) patients represented cases where the protocol for prophylactic IVC filter placement was not followed. Group 2: 11 patients (17%) were identified as direct primary pulmonary thrombosis (PPT) from the patient’s injury. All were diagnosed with a ‘PE’ within 48 hours of admission, had DVT and the thrombosis correlated with the location and severity of their chest trauma. All thrombi were in small segmental pulmonary arteries. Group 3: 19 patients (29%) had no high risk injuries and were not considered for filter placement, yet failed routine VTE prophylaxis. Most had prolonged immobilization, multiple surgeries or other risk factors. Group 4: 6 patients (9%) represent PPT with no high risk injuries, no direct lung trauma, and no DVT. All had thrombosis of small segmental vessels and only sepsis as a common factor.
Conclusion:
VTE remains a significant contributor to the morbidity and mortality of the trauma patient. One fourth of radiographic diagnosed ‘PE’ (groups 2 and 4) can be classified as PPT and not emboli.These VTE events are likely in situ pulmonary arterial thrombosis secondary to the patient’s injury itself or a result of hypercoagulability.Prospective studies of the natural history and treatment of PPT are needed.