Multiple lower-extremity and pelvic fractures increase pulmonary embolus risk

Area of Science:

• Trauma Surgery
• Pulmonary Medicine
• Epidemiology

Background:

• Venous thromboembolism (VTE) affects up to 60% of major trauma patients despite prophylaxis.
• Pulmonary embolism (PE) is a serious complication of deep vein thrombosis (DVT), leading to significant morbidity and mortality.

Purpose of the Study:

• To identify risk factors for pulmonary embolism (PE) in patients with pelvic and lower-extremity fractures.
• To analyze data from the National Trauma Data Bank (NTDB) to assess PE predictors.

Main Methods:

• Utilized univariate analysis and multiple logistic regression.
• Analyzed data from 199,952 patients with pelvic and lower-extremity fractures from the NTDB.
• Assessed risk factors for PE during the index hospitalization.

Main Results:

• A total of 918 patients (0.46%) experienced PE, with 117 (12%) fatalities.
• Multiple fractures (OR, 1.89) significantly increased PE risk; fracture location did not.
• Obesity (BMI >40, OR 3.38), warfarin history, surgery, ICU admission, and university hospital setting were associated with higher PE rates.

Conclusions:

• Multiple pelvic or lower-extremity fractures, not specific locations, are linked to PE.
• Obesity and prior warfarin use are confirmed risk factors for PE in trauma patients.
• This study provides crucial insights for identifying high-risk trauma patients for PE prevention.