Factors associated with pulmonary embolism within 72 hours of admission after trauma: A multicenter study

Jamie J. Coleman, Ben L. Zarzaur, Chad W. Katona, Zachary J. Plummer, Laura S. Johnson, Alison Fecher, Jamie M. O'Rear, David V. Feliciano, Grace S. Rozycki

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background Recent studies using thromboelastography indicate that patients are at risk for hypercoagulability early after injury. Pulmonary embolism (PE) is also well known to cause significant morbidity and mortality after injury and can occur within 72 hours of admission (early PE). Despite this risk, prophylactic anticoagulation is often delayed in patients with certain injuries due to concerns about bleeding. Study Design This was a retrospective study of injured patients with a PE from 2007 to 2013 at 3 level I trauma centers. Data collected included patient demographics, injury patterns, length of stay, timing of prophylaxis for deep vein thrombosis (DVT), and diagnosis of PE. Patients with early PE (≤3 days) were compared with those with late PE (3 days) using bivariate and multivariable analysis. Results A total of 54,964 patients were admitted to the 3 centers during the study period, and 144 (0.26%) were diagnosed with a PE. Eleven were excluded from the study due to a lack of critical data, leaving 133 patients (43% early PE). Factors associated with early PE included long bone fractures in the lower extremity and an Abbreviated Injury Score (AIS) Extremity ≥3. Higher Injury Severity Score, severe chest and head trauma (AIS ≥ 3), and not receiving DVT prophylaxis within 48 hours of hospital admission were not associated with early PE. Conclusions Early PE is a significant clinical entity occurring in nearly half the patients who suffered a PE. Early PE is associated with long bone fractures and severe extremity trauma, but not severe thoracic injury. Timing of prophylactic anticoagulation had no impact on early PE. If further studies confirm this incidence of unsuspected early PE, all admitted trauma patients should be assessed for a hypercoagulable state after injury.

Original languageEnglish (US)
Pages (from-to)731-736
Number of pages6
JournalJournal of the American College of Surgeons
Volume220
Issue number4
DOIs
StatePublished - Apr 1 2015

Fingerprint

Pulmonary Embolism
Multicenter Studies
Wounds and Injuries
Bone Fractures
Venous Thrombosis
Extremities
Thrombelastography
Thoracic Injuries
Injury Severity Score
Thrombophilia
Trauma Centers
Craniocerebral Trauma
Lower Extremity
Length of Stay
Cohort Studies
Thorax
Retrospective Studies

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Coleman, J. J., Zarzaur, B. L., Katona, C. W., Plummer, Z. J., Johnson, L. S., Fecher, A., ... Rozycki, G. S. (2015). Factors associated with pulmonary embolism within 72 hours of admission after trauma: A multicenter study. Journal of the American College of Surgeons, 220(4), 731-736. https://doi.org/10.1016/j.jamcollsurg.2014.12.032

Factors associated with pulmonary embolism within 72 hours of admission after trauma : A multicenter study. / Coleman, Jamie J.; Zarzaur, Ben L.; Katona, Chad W.; Plummer, Zachary J.; Johnson, Laura S.; Fecher, Alison; O'Rear, Jamie M.; Feliciano, David V.; Rozycki, Grace S.

In: Journal of the American College of Surgeons, Vol. 220, No. 4, 01.04.2015, p. 731-736.

Research output: Contribution to journalArticle

Coleman, JJ, Zarzaur, BL, Katona, CW, Plummer, ZJ, Johnson, LS, Fecher, A, O'Rear, JM, Feliciano, DV & Rozycki, GS 2015, 'Factors associated with pulmonary embolism within 72 hours of admission after trauma: A multicenter study', Journal of the American College of Surgeons, vol. 220, no. 4, pp. 731-736. https://doi.org/10.1016/j.jamcollsurg.2014.12.032
Coleman, Jamie J. ; Zarzaur, Ben L. ; Katona, Chad W. ; Plummer, Zachary J. ; Johnson, Laura S. ; Fecher, Alison ; O'Rear, Jamie M. ; Feliciano, David V. ; Rozycki, Grace S. / Factors associated with pulmonary embolism within 72 hours of admission after trauma : A multicenter study. In: Journal of the American College of Surgeons. 2015 ; Vol. 220, No. 4. pp. 731-736.
@article{3a7254c8e2c24ca3a062436c929dcbc4,
title = "Factors associated with pulmonary embolism within 72 hours of admission after trauma: A multicenter study",
abstract = "Background Recent studies using thromboelastography indicate that patients are at risk for hypercoagulability early after injury. Pulmonary embolism (PE) is also well known to cause significant morbidity and mortality after injury and can occur within 72 hours of admission (early PE). Despite this risk, prophylactic anticoagulation is often delayed in patients with certain injuries due to concerns about bleeding. Study Design This was a retrospective study of injured patients with a PE from 2007 to 2013 at 3 level I trauma centers. Data collected included patient demographics, injury patterns, length of stay, timing of prophylaxis for deep vein thrombosis (DVT), and diagnosis of PE. Patients with early PE (≤3 days) were compared with those with late PE (3 days) using bivariate and multivariable analysis. Results A total of 54,964 patients were admitted to the 3 centers during the study period, and 144 (0.26{\%}) were diagnosed with a PE. Eleven were excluded from the study due to a lack of critical data, leaving 133 patients (43{\%} early PE). Factors associated with early PE included long bone fractures in the lower extremity and an Abbreviated Injury Score (AIS) Extremity ≥3. Higher Injury Severity Score, severe chest and head trauma (AIS ≥ 3), and not receiving DVT prophylaxis within 48 hours of hospital admission were not associated with early PE. Conclusions Early PE is a significant clinical entity occurring in nearly half the patients who suffered a PE. Early PE is associated with long bone fractures and severe extremity trauma, but not severe thoracic injury. Timing of prophylactic anticoagulation had no impact on early PE. If further studies confirm this incidence of unsuspected early PE, all admitted trauma patients should be assessed for a hypercoagulable state after injury.",
author = "Coleman, {Jamie J.} and Zarzaur, {Ben L.} and Katona, {Chad W.} and Plummer, {Zachary J.} and Johnson, {Laura S.} and Alison Fecher and O'Rear, {Jamie M.} and Feliciano, {David V.} and Rozycki, {Grace S.}",
year = "2015",
month = "4",
day = "1",
doi = "10.1016/j.jamcollsurg.2014.12.032",
language = "English (US)",
volume = "220",
pages = "731--736",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Factors associated with pulmonary embolism within 72 hours of admission after trauma

T2 - A multicenter study

AU - Coleman, Jamie J.

AU - Zarzaur, Ben L.

AU - Katona, Chad W.

AU - Plummer, Zachary J.

AU - Johnson, Laura S.

AU - Fecher, Alison

AU - O'Rear, Jamie M.

AU - Feliciano, David V.

AU - Rozycki, Grace S.

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Background Recent studies using thromboelastography indicate that patients are at risk for hypercoagulability early after injury. Pulmonary embolism (PE) is also well known to cause significant morbidity and mortality after injury and can occur within 72 hours of admission (early PE). Despite this risk, prophylactic anticoagulation is often delayed in patients with certain injuries due to concerns about bleeding. Study Design This was a retrospective study of injured patients with a PE from 2007 to 2013 at 3 level I trauma centers. Data collected included patient demographics, injury patterns, length of stay, timing of prophylaxis for deep vein thrombosis (DVT), and diagnosis of PE. Patients with early PE (≤3 days) were compared with those with late PE (3 days) using bivariate and multivariable analysis. Results A total of 54,964 patients were admitted to the 3 centers during the study period, and 144 (0.26%) were diagnosed with a PE. Eleven were excluded from the study due to a lack of critical data, leaving 133 patients (43% early PE). Factors associated with early PE included long bone fractures in the lower extremity and an Abbreviated Injury Score (AIS) Extremity ≥3. Higher Injury Severity Score, severe chest and head trauma (AIS ≥ 3), and not receiving DVT prophylaxis within 48 hours of hospital admission were not associated with early PE. Conclusions Early PE is a significant clinical entity occurring in nearly half the patients who suffered a PE. Early PE is associated with long bone fractures and severe extremity trauma, but not severe thoracic injury. Timing of prophylactic anticoagulation had no impact on early PE. If further studies confirm this incidence of unsuspected early PE, all admitted trauma patients should be assessed for a hypercoagulable state after injury.

AB - Background Recent studies using thromboelastography indicate that patients are at risk for hypercoagulability early after injury. Pulmonary embolism (PE) is also well known to cause significant morbidity and mortality after injury and can occur within 72 hours of admission (early PE). Despite this risk, prophylactic anticoagulation is often delayed in patients with certain injuries due to concerns about bleeding. Study Design This was a retrospective study of injured patients with a PE from 2007 to 2013 at 3 level I trauma centers. Data collected included patient demographics, injury patterns, length of stay, timing of prophylaxis for deep vein thrombosis (DVT), and diagnosis of PE. Patients with early PE (≤3 days) were compared with those with late PE (3 days) using bivariate and multivariable analysis. Results A total of 54,964 patients were admitted to the 3 centers during the study period, and 144 (0.26%) were diagnosed with a PE. Eleven were excluded from the study due to a lack of critical data, leaving 133 patients (43% early PE). Factors associated with early PE included long bone fractures in the lower extremity and an Abbreviated Injury Score (AIS) Extremity ≥3. Higher Injury Severity Score, severe chest and head trauma (AIS ≥ 3), and not receiving DVT prophylaxis within 48 hours of hospital admission were not associated with early PE. Conclusions Early PE is a significant clinical entity occurring in nearly half the patients who suffered a PE. Early PE is associated with long bone fractures and severe extremity trauma, but not severe thoracic injury. Timing of prophylactic anticoagulation had no impact on early PE. If further studies confirm this incidence of unsuspected early PE, all admitted trauma patients should be assessed for a hypercoagulable state after injury.

UR - http://www.scopus.com/inward/record.url?scp=84925747944&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84925747944&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2014.12.032

DO - 10.1016/j.jamcollsurg.2014.12.032

M3 - Article

C2 - 25724603

AN - SCOPUS:84925747944

VL - 220

SP - 731

EP - 736

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 4

ER -