Fat embolism revisited

Despite continuing interest in fat embolism, the precise pathogenesis and the best treatment of the syndrome are still in doubt. To assess the effect of a high index of suspicion about the outcome of the syndrome, we have compared 37 patients seen from 1962 to 1968 with 16 patients seen from 1968 to 1974. The study of the original group of patients generated considerable interest in the diagnosis and management of the syndrome at our institution. The two groups are well matched for age, sex, and source of injury. The more recent group (1968-1974) seemed to have had more severe injuries as judged by number of fractures and need for blood transfusions. Despite this increase in severity of injury, the mortality rate for the period 1968-1974 was only 12.5% as opposed to 21% for the period 1962-1968. This improvement in mortality was achieved without resort to many of the popular pharmacologic regimens, including steroids and heparin. A high index of suspicion leading to an early diagnosis of respiratory dysfunction and aggressive supportive therapy has been responsible for the improved results.