Objective
To determine how soon after trauma pulmonary embolism (PE) occurs and if there is an association between the duration of this interval and mortality.
Design
Retrospective case series.
Patients
All patients admitted to our trauma service with established PE based on high probability findings on ventilation perfusion scan, positive results on a pulmonary arteriogram, or autopsy from July 1, 1990, to September 30, 1995.
Main Outcome Measure
Time interval between injury and PE.
Setting
Level I university trauma center.
Results
Of 18 255 trauma patients identified, 63 met our criteria for PE (30 using a pulmonary arteriogram; 26, a ventilation perfusion scan; and 7, autopsy). Four patients (6%) had a documented PE on day 1 following injury. Mortality was not correlated with the interval between injury and PE. Of the 63 patients, 58 (92%) had 1 or more established risk factors for thromboembolism. The ratio of PaO2 to fraction of inspired oxygen was the only factor predictive of mortality (P=.02, logistic regression analysis).
Conclusions
Pulmonary embolism occurs in the immediate period following injury. Aggressive workup in patients with signs consistent with PE should be instituted promptly. Trauma patients who have at least 1 risk factor for thromboembolism should receive prophylaxis as soon after injury as possible.
Arch Surg. 1997;132:862-867
