PULMONARY-EMBOLISM IN PEDIATRIC TRAUMA PATIENTS

Recent articles in the literature on adults have recommended prophylax is for pulmonary embolism (PE) in selected trauma patients; however, t o date no information is available regarding pediatric patients. We de cided to investigate whether the incidence of PE in pediatric trauma p atients is as high as that reported in adults, and identify those chil dren who might be at high risk and benefit from prophylactic treatment . Utilizing the data from the National Pediatric Trauma Registry (NPTR ), records were reviewed of all pediatric trauma patients (age < 19 ye ars) admitted to the participating institutions between December 1987 and February 1993. Patients with documented PE were identified as well as those having associated risk factors as identified in adult trauma patients (deep venous thrombosis, extremity injury, spinal cord injur y, and head injury). A total of 28,692 pediatric trauma patients were reviewed from the NPTR. The mean age was 9 years and the mean Injury S everity Score for the group was 11. Two thousand one children (7%) had serious head injuries (Glasgow Coma Scale score <8), over 5700 (20%) had an isolated extremity injury, 290 had an identified spinal cord in jury (108 with associated paralysis), and deep venous thrombosis was i dentified in 6 patients. Pulmonary embolism occurred in only two of th e children in this series. Both patients with PE had spinal cord injur ies with associated paraplegia, significant pulmonary injury, and high ISSs (25 and 27). The overall incidence of PE in the group was 0.0000 69%, and for those children with paralysis from spinal cord injury 1.8 5%. Although the literature suggests that PE is a common occurrence in adult trauma victims, it appears to be extremely rare in pediatric tr auma patients. From these data, the prophylaxis for PE recommended for adult patients appears unwarranted in injured children. Older teenage rs with paraplegia should be treated expectantly for PE, and prophylax is should be considered if confounding associated injuries are present .