Early Versus Late Pulmonary Embolism in Trauma Patients: Not All Pulmonary Embolisms are Created Similarly
| Autor: | Jeffry Nahmias, Dean Spencer, Matthew Dolich, Divya Ramakrishnan, Alyssa G. Ashbaugh, Areg Grigorian, Sahil Gambhir, Sebastian D. Schubl |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Blood transfusion medicine.medical_treatment Young Adult 03 medical and health sciences Injury Severity Score 0302 clinical medicine Trauma Centers Risk Factors Internal medicine medicine Humans Risk factor Aged Retrospective Studies Venous Thrombosis business.industry Smoking Trauma center Odds ratio Middle Aged medicine.disease Confidence interval Pulmonary embolism Venous thrombosis 030220 oncology & carcinogenesis Wounds and Injuries Female 030211 gastroenterology & hepatology Surgery Pulmonary Embolism Complication business |
| Zdroj: | Journal of Surgical Research. 239:174-179 |
| ISSN: | 0022-4804 |
| Popis: | Background Pulmonary embolism (PE) is an uncommon complication occurring in up to 5% of trauma patients. In small previous studies, patients with long-bone fractures were associated with a higher risk of early PE while those with severe head injuries were at higher risk for late PE. Materials and methods This was a retrospective analysis at a single level I trauma center from 2010 to 2017. Patients with early PE (≤4 d) were compared to those with late PE (>4 d) using bivariate analysis and multivariable logistic regression analysis. We sought to confirm risk factors for early and late PE, hypothesizing that early PE is associated with long-bone fractures and late PE is associated with above-the-knee deep venous thrombosis (DVT). Results From 12,833 trauma admissions, 76 patients (0.6%) had a PE. Of these, 33 (43.4%) had an early PE and 43 (54.6%) were diagnosed with late PE. After adjusting for covariates, independent risk factors for late PE included above-the-knee DVT (odds ratio [OR] = 12.01, confidence interval [CI] = 1.34-107.52, P = 0.03), blood transfusion (OR = 8.99, CI = 1.75-46.22, P = 0.009), and craniotomy (OR = 8.82, CI = 1.03-75.97, P = 0.04), while the only independent risk factor for early PE was smoking (OR = 4.56, CI 1.06-19.66, P = 0.04). Severe head injury and long-bone fractures were not risk factors for early or late PE (P > 0.05) Conclusions The strongest risk factor for late PE is above-the-knee DVT. Contrary to previous reports, long-bone extremity fractures and severe head injuries are not associated with early or late PE. The only risk factor for early PE was a history of smoking. |
| Databáze: | OpenAIRE |
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