International Journal of General Medicine (Oct 2022)

Clinical Characteristics and Risk Factors for Early versus Late Pulmonary Embolism in Trauma Patients: A Retrospective, Observational Study

  • Siddiqui T,
  • Asim M,
  • Ahmed K,
  • Mathradikkal S,
  • Bakhsh Z,
  • Masood M,
  • Al-Hassani A,
  • Nabir S,
  • Ahmed N,
  • Strandvik G,
  • El-Menyar A,
  • Al-Thani H

Journal volume & issue
Vol. Volume 15
pp. 7867 – 7878

Abstract

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Tariq Siddiqui,1 Mohammad Asim,2 Khalid Ahmed,1 Saji Mathradikkal,1 Zeenat Bakhsh,1 Maarij Masood,1 Ammar Al-Hassani,1 Syed Nabir,3 Nadeem Ahmed,3 Gustav Strandvik,1 Ayman El-Menyar,2,4 Hassan Al-Thani1 1Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar; 2Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar; 3Radiology Department, Hamad General Hospital, Doha, Qatar; 4Clinical Medicine, Weill Cornell Medical College, Doha, QatarCorrespondence: Ayman El-Menyar, Trauma & Vascular Surgery Section, Hamad Medical Corporation & Weill Cornell Medical College, PO Box 3050, Doha, Qatar, Tel +97444396130, Email [email protected]: We sought to evaluate the clinical characteristics and risk factors for early versus late pulmonary embolism (PE) in trauma patients.Methods: This was a retrospective analysis of injured patients who presented with a confirmed PE between 2013 and 2019. Data were analysed and compared for patients with early PE (≤ 4 days) versus late PE (> 4 days post-trauma).Results: The study included 82 consecutive trauma patients with confirmed diagnosis of PE. The mean age of patients was 42.3 ± 16.2 years. The majority were males (79.3%) and the median time from injury to PE was 10 days. Of the PE cases, 24 (29.3%) had early PE, while 58 (70.7%) had late PE. The early PE group had higher rates of surgical intervention within 24 hours of admission than the late PE group (p = 0.001). Also, the rate of sub-segmental thrombi was significantly higher in the early PE group (p = 0.01). The late PE group sustained more moderate-to-severe injuries ie, GCS ED < 13 (p = 0.03) and the median time from injury to PE diagnosis was 15 days (p = 0.001). After adjusting for the potential covariates, surgery within 24 hours of admission [adjusted odds ratio 37.58 (95% confidence interval 3.393– 416.20), p = 0.003] was found to be significant independent predictor of early PE in trauma patients.Conclusion: One-third of post-trauma PEs occurs early after trauma and the surgical intervention within the first 24 hours of admission is a major risk factor. A prospective study is needed to develop an objective risk assessment for the prevention and detection of early and late PE post-trauma.Keywords: pulmonary embolism, trauma, timing, risk factors, outcomes

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