Treatment and complications in orthopaedic trauma patients with symptomatic pulmonary embolism

Yelena Bogdan, Paul Tornetta, Ross Leighton, Uwe Dahn, Henry Sagi, Charles Nalley, David Sanders, Jodi Siegel, Brian Mullis, Thomas Bemenderfer, Heather Vallier, Alysse Boyd, Andrew Schmidt, J. R. Westberg, Kenneth A. Egol, Stephen Kottmeier, Cory Collinge

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: The purpose of this study is to characterize the presentation, size, treatment, and complications of pulmonary embolism (PE) in a large series of orthopaedic trauma patients who developed PE after injury. Methods: We reviewed the records of orthopaedic trauma patients who developed a PE within 6 months of injury at 9 trauma centers and 2 tertiary care facilities. Results: There were 312 patients, 186 men and 126 women, average age 58 years. Average body mass index was 29.6, and average Injury Severity Score was 18. Seventeen percent received anticoagulation before injury, and 5% had a history of PE. After injury, 87% were placed on prophylactic anticoagulation and 68% with low-molecular weight heparin. Fifty-three percent of patients exhibited shortness of breath or chest pain. Average heart rate and O2 saturation before PE diagnosis were 110 and 94%, respectively. Thirty-nine percent had abnormal arterial blood gas, and 30% had abnormal electrocardiogram findings. Eighty-nine percent had computed tomography pulmonary angiography for diagnosis. Most clots were segmental (63%), followed by subsegmental (21%), lobar (9%), and central (7%). The most common treatment was unfractionated heparin and Coumadin (25%). Complications of anticoagulation were common: 10% had bleeding at the surgical site. Other complications of anticoagulation included gastrointestinal bleed, anemia, wound complications, death, and compartment syndrome. PE recurred in 1% of patients. Four percent died of PE within 6 months. Conclusions: This is the first large data set to evaluate the course of PE in an orthopaedic trauma population. The complications of anticoagulation are significant and were as common in patients with lower risk clots as those with higher risk clots. Level of evidence: III (retrospective). See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish
JournalJournal of Orthopaedic Trauma
Volume28
Issue numberSUPPL. 1
DOIs
StatePublished - 2014

Fingerprint

Pulmonary Embolism
Orthopedics
Wounds and Injuries
Therapeutics
Compartment Syndromes
Injury Severity Score
Trauma Centers
Low Molecular Weight Heparin
Warfarin
Tertiary Healthcare
Chest Pain
Dyspnea
Heparin
Anemia
Electrocardiography
Body Mass Index
Heart Rate
Gases
Hemorrhage
Lung

Keywords

  • anticoagulation
  • orthopaedic trauma
  • pulmonary embolism

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Bogdan, Y., Tornetta, P., Leighton, R., Dahn, U., Sagi, H., Nalley, C., ... Collinge, C. (2014). Treatment and complications in orthopaedic trauma patients with symptomatic pulmonary embolism. Journal of Orthopaedic Trauma, 28(SUPPL. 1). https://doi.org/10.1097/BOT.0000000000000061

Treatment and complications in orthopaedic trauma patients with symptomatic pulmonary embolism. / Bogdan, Yelena; Tornetta, Paul; Leighton, Ross; Dahn, Uwe; Sagi, Henry; Nalley, Charles; Sanders, David; Siegel, Jodi; Mullis, Brian; Bemenderfer, Thomas; Vallier, Heather; Boyd, Alysse; Schmidt, Andrew; Westberg, J. R.; Egol, Kenneth A.; Kottmeier, Stephen; Collinge, Cory.

In: Journal of Orthopaedic Trauma, Vol. 28, No. SUPPL. 1, 2014.

Research output: Contribution to journalArticle

Bogdan, Y, Tornetta, P, Leighton, R, Dahn, U, Sagi, H, Nalley, C, Sanders, D, Siegel, J, Mullis, B, Bemenderfer, T, Vallier, H, Boyd, A, Schmidt, A, Westberg, JR, Egol, KA, Kottmeier, S & Collinge, C 2014, 'Treatment and complications in orthopaedic trauma patients with symptomatic pulmonary embolism', Journal of Orthopaedic Trauma, vol. 28, no. SUPPL. 1. https://doi.org/10.1097/BOT.0000000000000061
Bogdan, Yelena ; Tornetta, Paul ; Leighton, Ross ; Dahn, Uwe ; Sagi, Henry ; Nalley, Charles ; Sanders, David ; Siegel, Jodi ; Mullis, Brian ; Bemenderfer, Thomas ; Vallier, Heather ; Boyd, Alysse ; Schmidt, Andrew ; Westberg, J. R. ; Egol, Kenneth A. ; Kottmeier, Stephen ; Collinge, Cory. / Treatment and complications in orthopaedic trauma patients with symptomatic pulmonary embolism. In: Journal of Orthopaedic Trauma. 2014 ; Vol. 28, No. SUPPL. 1.
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abstract = "Objectives: The purpose of this study is to characterize the presentation, size, treatment, and complications of pulmonary embolism (PE) in a large series of orthopaedic trauma patients who developed PE after injury. Methods: We reviewed the records of orthopaedic trauma patients who developed a PE within 6 months of injury at 9 trauma centers and 2 tertiary care facilities. Results: There were 312 patients, 186 men and 126 women, average age 58 years. Average body mass index was 29.6, and average Injury Severity Score was 18. Seventeen percent received anticoagulation before injury, and 5{\%} had a history of PE. After injury, 87{\%} were placed on prophylactic anticoagulation and 68{\%} with low-molecular weight heparin. Fifty-three percent of patients exhibited shortness of breath or chest pain. Average heart rate and O2 saturation before PE diagnosis were 110 and 94{\%}, respectively. Thirty-nine percent had abnormal arterial blood gas, and 30{\%} had abnormal electrocardiogram findings. Eighty-nine percent had computed tomography pulmonary angiography for diagnosis. Most clots were segmental (63{\%}), followed by subsegmental (21{\%}), lobar (9{\%}), and central (7{\%}). The most common treatment was unfractionated heparin and Coumadin (25{\%}). Complications of anticoagulation were common: 10{\%} had bleeding at the surgical site. Other complications of anticoagulation included gastrointestinal bleed, anemia, wound complications, death, and compartment syndrome. PE recurred in 1{\%} of patients. Four percent died of PE within 6 months. Conclusions: This is the first large data set to evaluate the course of PE in an orthopaedic trauma population. The complications of anticoagulation are significant and were as common in patients with lower risk clots as those with higher risk clots. Level of evidence: III (retrospective). See Instructions for Authors for a complete description of levels of evidence.",
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AU - Bogdan, Yelena

AU - Tornetta, Paul

AU - Leighton, Ross

AU - Dahn, Uwe

AU - Sagi, Henry

AU - Nalley, Charles

AU - Sanders, David

AU - Siegel, Jodi

AU - Mullis, Brian

AU - Bemenderfer, Thomas

AU - Vallier, Heather

AU - Boyd, Alysse

AU - Schmidt, Andrew

AU - Westberg, J. R.

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AU - Collinge, Cory

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N2 - Objectives: The purpose of this study is to characterize the presentation, size, treatment, and complications of pulmonary embolism (PE) in a large series of orthopaedic trauma patients who developed PE after injury. Methods: We reviewed the records of orthopaedic trauma patients who developed a PE within 6 months of injury at 9 trauma centers and 2 tertiary care facilities. Results: There were 312 patients, 186 men and 126 women, average age 58 years. Average body mass index was 29.6, and average Injury Severity Score was 18. Seventeen percent received anticoagulation before injury, and 5% had a history of PE. After injury, 87% were placed on prophylactic anticoagulation and 68% with low-molecular weight heparin. Fifty-three percent of patients exhibited shortness of breath or chest pain. Average heart rate and O2 saturation before PE diagnosis were 110 and 94%, respectively. Thirty-nine percent had abnormal arterial blood gas, and 30% had abnormal electrocardiogram findings. Eighty-nine percent had computed tomography pulmonary angiography for diagnosis. Most clots were segmental (63%), followed by subsegmental (21%), lobar (9%), and central (7%). The most common treatment was unfractionated heparin and Coumadin (25%). Complications of anticoagulation were common: 10% had bleeding at the surgical site. Other complications of anticoagulation included gastrointestinal bleed, anemia, wound complications, death, and compartment syndrome. PE recurred in 1% of patients. Four percent died of PE within 6 months. Conclusions: This is the first large data set to evaluate the course of PE in an orthopaedic trauma population. The complications of anticoagulation are significant and were as common in patients with lower risk clots as those with higher risk clots. Level of evidence: III (retrospective). See Instructions for Authors for a complete description of levels of evidence.

AB - Objectives: The purpose of this study is to characterize the presentation, size, treatment, and complications of pulmonary embolism (PE) in a large series of orthopaedic trauma patients who developed PE after injury. Methods: We reviewed the records of orthopaedic trauma patients who developed a PE within 6 months of injury at 9 trauma centers and 2 tertiary care facilities. Results: There were 312 patients, 186 men and 126 women, average age 58 years. Average body mass index was 29.6, and average Injury Severity Score was 18. Seventeen percent received anticoagulation before injury, and 5% had a history of PE. After injury, 87% were placed on prophylactic anticoagulation and 68% with low-molecular weight heparin. Fifty-three percent of patients exhibited shortness of breath or chest pain. Average heart rate and O2 saturation before PE diagnosis were 110 and 94%, respectively. Thirty-nine percent had abnormal arterial blood gas, and 30% had abnormal electrocardiogram findings. Eighty-nine percent had computed tomography pulmonary angiography for diagnosis. Most clots were segmental (63%), followed by subsegmental (21%), lobar (9%), and central (7%). The most common treatment was unfractionated heparin and Coumadin (25%). Complications of anticoagulation were common: 10% had bleeding at the surgical site. Other complications of anticoagulation included gastrointestinal bleed, anemia, wound complications, death, and compartment syndrome. PE recurred in 1% of patients. Four percent died of PE within 6 months. Conclusions: This is the first large data set to evaluate the course of PE in an orthopaedic trauma population. The complications of anticoagulation are significant and were as common in patients with lower risk clots as those with higher risk clots. Level of evidence: III (retrospective). See Instructions for Authors for a complete description of levels of evidence.

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