TIMING OF THE OCCURRENCE OF PULMONARY-EMBOLISM IN TRAUMA PATIENTS

Objective: To determine how soon after trauma pulmonary embolism (PE) occurs and if there is an association between the duration of this int erval and mortality. Design: Retrospective case series. Patients: All patients admitted to our trauma service with established PE based on h igh probability findings on ventilation perfusion scan, positive resul ts on a pulmonary arteriogram, or autopsy from July 1, 1990, to Septem ber 30, 1995. Main Outcome Measures: Time interval between injury and PE. Setting: Level I university trauma center. Results: Of 18255 traum a patients identified, 63 met our criteria for PE (30 using a pulmonar y arteriogram; 26, a ventilation perfusion scan; and 7, autopsy). Four patients (6%) had a documented PE on day 1 following injury. Mortalit y was not correlated with the interval between injury and PE. Of the 6 3 patients, 58 (92%) had 1 or mor established risk factors for thrombo embolism. The ratio of PaO2 to fraction of inspired oxygen was the onl y factor predictive of mortality (P=02, logistic regression analysis). Conclusions: Pulmonary embolism occurs in the immediate period follow ing injury. Aggressive workup in patients with signs consistent with P E should be instituted promptly. Trauma patients who have a least 1 ri sk factor for thromboembolism should receive prophylaxis as soon after injury as possible.