A cohort study on the incidence and outcome of pulmonary embolism in trauma and orthopedic patients

BMC Medicine

Peter V Giannoudis²  Robert M West¹  Nikolaos K Kanakaris³  Petros Z Stavrou³  Simon J Harrison³  Vincenzo Ciriello³  Evangelos M Fragkakis³  Suribabu Gudipati³ 

[1] Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, LS2 9LJ Leeds, West Yorkshire, UK;Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA Leeds, West Yorkshire, UK;Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Clarendon Wing Level A, Great George Street, LS1 3EX Leeds, West Yorkshire, UK

关键词: Incidence;    Mortality;    Arthroplasty;    Orthopedic surgery;    Trauma;    Deep venous thrombosis;    Pulmonary embolism;   

Others  :  854959
DOI  :  10.1186/1741-7015-12-39

 received in 2013-08-03, accepted in 2014-02-11,  发布年份 2014

【 摘 要 】

Background

This study aims to determine the incidence of pulmonary embolism (PE) in trauma and orthopedic patients within a regional tertiary referral center and its association with the pattern of injury, type of treatment, co-morbidities, thromboprophylaxis and mortality.

Methods

All patients admitted to our institution between January 2010 and December 2011, for acute trauma or elective orthopedic procedures, were eligible to participate in this study. Our cohort was formed by identifying all patients with clinical features of PE who underwent Computed Tomography-Pulmonary Angiogram (CT-PA) to confirm or exclude the clinical suspicion of PE, within six months after the injury or the surgical procedure.

Case notes and electronic databases were reviewed retrospectively to identify each patient’s venous thromboembolism (VTE) risk factors, type of treatment, thromboprophylaxis and mortality.

Results

Out of 18,151 patients admitted during the study period only 85 (0.47%) patients developed PE (positive CT-PA) (24 underwent elective surgery and 61 sustained acute trauma). Of these, only 76% of the patients received thromboprophylaxis. Hypertension, obesity and cardiovascular disease were the most commonly identifiable risk factors. In 39% of the cases, PE was diagnosed during the in-hospital stay. The median time of PE diagnosis, from the date of injury or the surgical intervention was 23 days (range 1 to 312). The overall mortality rate was 0.07% (13/18,151), but for those who developed PE it was 15.29% (13/85). Concomitant deep venous thrombosis (DVT) was identified in 33.3% of patients. The presence of two or more co-morbidities was significantly associated with the incidence of mortality (unadjusted odds ratio (OR) = 3.52, 95% confidence interval (CI) (1.34, 18.99), P = 0.034). Although there was also a similar clinical effect size for polytrauma injury on mortality (unadjusted OR = 1.90 (0.38, 9.54), P = 0.218), evidence was not statistically significant for this factor.

Conclusions

The incidence of VTE was comparable to previously reported rates, whereas the mortality rate was lower. Our local protocols that comply with the National Institute for Health and Clinical Excellence (NICE) guidelines in the UK appear to be effective in preventing VTE and reducing mortality in trauma and orthopedic patients.

【 授权许可】

   
2014 Gudipati et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 8.

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