Incidence of Asymptomatic Pulmonary Embolism in Moderately to Severely Injured Trauma Patients

David J. Schultz, Karen J. Brasel, Lacey Washington, Lawrence R. Goodman, Robert R. Quickel, Randolph J. Lipchik, Todd Clever, John Weigelt, David H. Wisner, Tetsuo Yukika, George C. Velmahos, John T. Owings, Daniel R. Margulies, Susan M. Briggs, Michael L. Hawkins, Carol R. Schermer

Research output: Contribution to journalArticle

130 Scopus citations

Abstract

Background: Chest computed tomographic (CT) scanning is used frequently to evaluate symptomatic patients for pulmonary embolus (PE). The incidence of PE diagnosed by helical CT scanning in asymptomatic patients is unknown. Methods: Asymptomatic trauma patients with an Injury Severity Score ≥ 9 were studied with contrast-enhanced helical CT images of the chest, pelvis, and lower extremities. Clot burden was assessed using an anatomic scoring system. Patients not receiving anticoagulation were followed. Results: Twenty-two of 90 patients had a PE. Four had major clot burden, including one patient with a saddle embolus. Risk factors for asymptomatic PE include age (odds ratio [OR], 1.04), head injury (OR, 6.78), chest injury (OR, 4.51), lower extremity injury (OR, 5.03), and transfusion (OR, 3.42). Thirty percent of patients receiving pharmacologic prophylaxis had a PE. Conclusion: Asymptomatic PE occur in 24% of moderately to severely injured patients. Age, head, chest, and lower extremity injury are associated with an increased risk. Standard thromboembolic prophylaxis is not reliably protective.

Original languageEnglish (US)
Pages (from-to)727-733
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume56
Issue number4
DOIs
Publication statusPublished - Jan 1 2004
Externally publishedYes

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Keywords

  • Chest injury
  • Computed tomographic scanning
  • Head injury
  • Pulmonary embolus
  • Transfusion

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Schultz, D. J., Brasel, K. J., Washington, L., Goodman, L. R., Quickel, R. R., Lipchik, R. J., ... Schermer, C. R. (2004). Incidence of Asymptomatic Pulmonary Embolism in Moderately to Severely Injured Trauma Patients. Journal of Trauma - Injury, Infection and Critical Care, 56(4), 727-733. https://doi.org/10.1097/01.TA.0000119687.23542.EC