Incidence and Risk Factors for Venous Thromboembolism in Hemodynamically Unstable Pelvic Fractures

Pelvic fractures can cause severe hemorrhage and instability in trauma patients. The association between pelvic fracture morphology, venous thromboembolism (VTE) risk, and clinical outcomes remains unclear. This study evaluates the incidence, risk factors, characteristics, and outcomes of VTE in hemodynamically unstable pelvic fractures.

This retrospective cohort study included adult trauma patients with blunt pelvic ring disruptions and hemorrhagic shock (systolic blood pressure <90 mmHg) admitted to an American College of Surgeons-verified Level I adult trauma center between January 1, 2022 and May 31, 2023. Demographic and clinical data were abstracted from the electronic medical record. The primary outcome was in-hospital VTE. Secondary outcomes included intensive care unit and hospital length of stay (LOS) and mortality.

Of 133 patients, 32 (24.1%) developed VTE (4.5% deep vein thrombosis alone, 12.8% pulmonary embolism alone, 6.8% both). VTE was diagnosed a median of 7 d after admission. Nearly all patients received early chemoprophylaxis (median initiation hospital day 1), with no differences in timing by VTE status or fracture pattern (P > 0.05). Fracture morphology was not independently associated with VTE. VTE was associated with longer intensive care unit LOS (11.5 versus 5.0 d, P < 0.001) and hospital LOS (20.5 versus 17.0 d, P = 0.028), though mortality did not differ. In multivariable regression, no independent associations were found between VTE and age, sex, body mass index, or injury severity score.

VTE was common despite early chemoprophylaxis. Fracture morphology did not independently predict VTE. Early VTE timing underscores the need for vigilant surveillance and uninterrupted prophylaxis. Prospective studies are needed.