American Surgical Association

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2332 Post Traumatic Pulmonary Emboli: A New Look At An Old Disease
Mary M Knudson, MD1, David Gomez Jaramillo, MD*2, Avery B Nathens, MD2
1Univeristy of California, San Francisco, San Francisco, CA;2St. Michael's Hospital, Toronto, ON, Canada

OBJECTIVES: Despite compliance with prophylactic measures, pulmonary emboli (PE) remain a threat to post-injury recovery. We hypothesized that the liberal use of chest CT after trauma has resulted in an increased rate of detection of PE but a decreased rate of PE-associated mortality.
METHODS: We examined demographics, injury data, risk factors, and outcomes from patients with DVT and PE compiled in recent years (2007-2009) in the National Trauma Data Bank. Statistical models were created to examine predictors of DVT and PE and of PE-related mortality.
RESULTS: Among 519,268 patients from 192 centers, 2332 PE were reported (incidence of 0.45% compared to 0.13% 10 years ago). Mortality among patients with PE was 8.9% compared to `18.7% in our earlier report (adjusted OR of death for PE 2.3 (1.94-2.71). Risk factors for DVT and PE are not equivalent (Table). Severe chest injury is an independent predictor for PE but not DVT.
CONCLUSIONS: The reported incidence of PE after trauma has tripled in recent years but the attributable mortality has decreased by 50% suggesting that we are identifying a different disease entity or stage. Chest injuries are an independent predictor of PE and would likely not be prevented by an IVC filter.


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