Guy E. Johnson MD, Presenter: Nothing to Disclose

Claire Kalsch Sandstrom MD, Abstract Co-Author: Nothing to Disclose

Giridhar Mysore Shivaram MD, Abstract Co-Author: Nothing to Disclose

Sudhakar N. Pipavath MD, Abstract Co-Author: Research grant, General Electric Company

Karim Valji MD, Abstract Co-Author: Royalties, Reed Elsevier

Martin Lee David Gunn MBChB, Abstract Co-Author: Editor, Wolters Kluwer NV Spouse is consultant, Wolters Kluwer NV

To investigate the timing of pulmonary embolism (PE) following trauma and factors associated with the timing of PE.

Radiology information system and trauma registry records from a level one trauma center were searched for all cases of PE that occurred following trauma during the trauma admission. This retrospective analysis spanned from January 1, 2000 to April 15, 2010.  Data collected included timing of PE following trauma, injuries and other relevant clinical information including mortality.  

There were a total of 387 cases of PE diagnosed in 63,213 trauma patients. Pulmonary embolism was diagnosed as from day 0 to day 102. Thirty seven cases (9.6%) were diagnosed on day 0, with most (31; 84%) diagnosed incidentally on initial imaging, representing 8% of all PEs. Peak diagnostic incidence occurred on day 3 (46 cases, 11.9%). Forty-three percent of all PE cases (166) occurred on or before day 4. Overall, the mean injury severity score (ISS) was 26.2, with no difference between groups based on interval to PE, with the exception of patients who were diagnosed with PE on day 1. The ISS for this group was significantly lower at 15.9 (P<0.0001). Overall, there were 32 deaths (8.2%). Eight occurred in the day 0 group (21.6% of patients in the group).

Pulmonary embolism is a feared complication seen following trauma. To date, there is little published data regarding the onset of PE following trauma. To our knowledge, there are only a handful of cases reported that describe PE diagnosed on initial trauma workup. We describe a large set of cases of PE from a level one trauma center that indicates PE may occur much earlier following trauma than previously thought. In our series, 9.6% of patients with PE after trauma were diagnosed on day 0 following trauma, and there was an increased mortality in this group. 

Previously poorly described, recognition of the startlingly high prevalence of early PE following trauma may lead to improved treatment and patient outcomes.

Johnson, G, Sandstrom, C, Shivaram, G, Pipavath, S, Valji, K, Gunn, M, Early Acute Pulmonary Embolism Following Trauma.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11008565.html