TY - JOUR
T1 - Incidence of Asymptomatic Pulmonary Embolism in Moderately to Severely Injured Trauma Patients
AU - Schultz, David J.
AU - Brasel, Karen J.
AU - Washington, Lacey
AU - Goodman, Lawrence R.
AU - Quickel, Robert R.
AU - Lipchik, Randolph J.
AU - Clever, Todd
AU - Weigelt, John
AU - Wisner, David H.
AU - Yukika, Tetsuo
AU - Velmahos, George C.
AU - Owings, John T.
AU - Margulies, Daniel R.
AU - Briggs, Susan M.
AU - Hawkins, Michael L.
AU - Schermer, Carol R.
PY - 2004/4
Y1 - 2004/4
N2 - 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.
AB - 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.
KW - Chest injury
KW - Computed tomographic scanning
KW - Head injury
KW - Pulmonary embolus
KW - Transfusion
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U2 - 10.1097/01.TA.0000119687.23542.EC
DO - 10.1097/01.TA.0000119687.23542.EC
M3 - Article
C2 - 15187734
AN - SCOPUS:11144356709
SN - 0022-5282
VL - 56
SP - 727
EP - 733
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 4
ER -