Violent death and Post-traumatic pulmonary embolism during hospital admission

Fatal pulmonary embolism (PE) is a multifactorial entity that is often associated with trauma and has an unpredictable course associated with high in-hospital mortality. This study aimed to understand if there was a relationship between the hospitalization conditions of trauma patients, their clinical and demographic characteristics, and the correlation between the occurrence of fatal pulmonary thromboembolism and the time interval between this event and the initial traumatic incident in this context. This is a retrospective and observational study of 22 trauma patients whose death was verified in-hospital between 2018 and 2020. Descriptive analysis and non-parametric association tests were performed. Of the 22 patients included, the cause of death in 8 patients (36.4%) was an early PE and in the remaining (63.6%) a late PE. The hospitalization had a median of 6 days (IQR = 26). In the statistical analysis, there were statistically relevant differences in the groups according to time of PE regarding the gender (p = .026) and period of immobilization (p = .002). These comparisons did not reach statistical significance, but moderate-to-large exploratory effect sizes were observed for the type of trauma (p = .076, Φ_c = 0.63), the injured anatomical area (p = .355; Φ_c = 0.58), the surgical procedures (p = .661, Φ_c = 0.52) and the location of the emboli in the pulmonary tree (p = .270, Φ_c = 0.56), according to time of PE; given the small sample size, these findings should be regarded as hypothesis-generating and require confirmation in larger cohorts. Post-traumatic PE is a high mortality entity, and these data may contribute to the medico-legal assessment of the temporal relationship between trauma and PE; optimizing the thromboembolus histological dating system remains essential to move from temporal compatibility towards a more robust assessment of causality.