Pulmonary embolism in patients with traumatic brain injury in the United States during 2016-2020

This study aims to find the incidence of pulmonary embolism (PE) in traumatic brain injury (TBI) and the impact of comorbidities on the development of PE in the United States.

This is a retrospective study of inpatient subjects from 2016 to 2020 in the United Stateswith TBI collected from the Healthcare Cost and Utilization Project (HCUP). Patients were evaluated for demographics, types of TBI, comorbidities, and complications. Regression statistical analyses were conducted to find the odds of developing PE after TBI.

219,005 TBI cases were included, of which 1,367 developed PE (0.6%). The cohort was mostly white (71%), and males (60%), with a mean age of 61.75 y/o. The patients who developed PE were younger (60.36 vs. 61.76, p < 0.001), had longer hospital stays (18.6 vs. 6.8 days, p < 0.001), and had significantly higher mortality (14% vs. 8%, p < 0.001). In multivariate analysis, having lower DVT (OR 10.16 [9.07-11.39], p < 0.001), upper DVT (OR 2.78 [2.26-3.42], p < 0.001), pneumonia (OR 1.35 [1.21-1.51], p < 0.001), myocardial infarction (OR 1.28 [1.00-1.63], p = 0.049), and sepsis (OR 1.26 [1.08-1.48], p = 0.004), had the highest association with developing PE following TBI.

Our data show that the incidence of PE in TBI patients is low; however, it is lethal with longer hospital stay. The risk of PE is higher in those with comorbidities such as paralysis, AIDS/HIV, metastatic cancer, and fluid/electrolyte disorders.