J. B. Wilkerson2,5, B. Andrew1,2, W. Charles2,3, H. B. John2,3, G. Matthew1, B. Sarah2,4, F. Erin2,3, J. Tomasek2, P. Matthew2,3, J. L. Gary1 1University Of Texas Health Science Center At Houston,Department Of Orthopedics,Houston, TX, USA 2Center For Translational Injury Research,Houston, TX, USA 3University Of Texas Health Science Center At Houston,Department Of Surgery,Houston, TX, USA 4University Of Texas Health Science Center At Houston,Department Of Biostatistics,Houston, TX, USA 5University Of Texas Health Science Center At Houston,Medical School,Houston, TX, USA
Introduction: Pulmonary embolism (PE) can be a deadly outcome for trauma patients despite aggressive surveillance and prophylaxis. Thromboelastography (TEG) has recently come into focus as a method for screening injured patients for hypercoagulability and risk for pulmonary embolism. The maximal amplitude (mA) value, representative of clot strength, is currently used to assess patient risk of PE in our trauma center. The purpose of this study is to determine whether the location of injury (upper extremity, lower extremity/pelvic, or spinal column) affects the risk of PE in orthopaedic trauma patients. It is hypothesized that patients with an isolated lower extremity/pelvic fracture will have higher mA values, predicting a higher risk for PE.
Methods: The study included all patients admitted with admission TEG between January 1, 2011 and July 15, 2014 at a large level I trauma center. Subjects included patients ages 16 and older suffering a fracture from proximal humerus to distal radius (upper extremity), from pelvis to talus (lower extremity), or along the spinal column. Patients were excluded if their PE was diagnosed before arrival.
Results: 1877 musculoskeletal trauma patients were included in the study. 176 (9.4%) were diagnosed with PE. 1.4% of patients with an isolated upper extremity injury, 4.7% of patients with an isolated lower extremity injury, and 42.5% of patients with an isolated spinal column injury developed a PE. Also, 11.5% of the patients with injuries to more than one of these locations (“poly-trauma”) developed a PE. Two-tailed T tests were used to compare the average mA values between these injury groups, accounting for race, gender, and age. The mean mA and p values are shown in the table below for the different groups compared.
Conclusion: There was no significant difference in mean mA values across the stratified injury groups to indicate a difference in risk for PE. The elevated mA values seen in both PE and non-PE groups could be explained by the fact that all patients in the cohort underwent musculoskeletal injury, which could contribute to patient hypercoagulability. Further study should be performed to determine if specific fractures within these injury subsets have significantly different mA values and risk for PE. The relationship of mA values to timing of PE should be investigated.
