Department of Surgery, Allegheny General Hospital, Pittsburgh, PA.
Surgery. 2013 Oct;154(4):810-4; discussion 814-5. doi: 10.1016/j.surg.2013.04.045.
Patients with traumatic brain injury (TBI) are assumed to be at an increased risk for pulmonary embolism (PE). Delay in the initiation of chemoprophylaxis and prophylactic placement of inferior vena cava filters have been advocated by some because of concerns for increased intracranial hemorrhage in the presence of prophylactic anticoagulation. We hypothesized that patients with isolated TBI would not be at increased risk for the development of PE compared with the general trauma population.
Patients from the National Trauma Data Bank from the year 2008 were analyzed. Patient demographics, Injury Severity Score, and the prevalence of deep-vein thrombosis and PE were extracted. Studied injuries were assigned to six categories: thorax, abdominal solid organs, pelvic fracture, lower extremity fracture, spine fracture, and TBI.
Of a total of 627,775 injured patients, 2,182 (0.35%) had a documented PE. The prevalence of PE in patients with isolated TBI, lower extremity, pelvic fracture, liver and/or spleen, thorax, spine, multiple injuries, and none of the studied injuries were 0.25%, 0.36%, 0.35%, 0.37%, 0.52%, 0.37%, 1.1%, and 0.12%, respectively. Using an age-, sex- and race-adjusted multivariable logistic regression model and controlling for interaction between inferior vena cava filters and injury types, we found that isolated TBI was not associated with PE.
Isolated TBI does not appear to be associated with an increased incidence of PE compared with other injuries. Patients with isolated TBI may not require early aggressive prophylaxis as is the standard for other high-risk groups.
据推测，创伤性脑损伤（TBI）患者发生肺栓塞（PE）的风险增加。由于担心预防性抗凝治疗会增加颅内出血，一些人主张延迟开始化学预防和预防性放置下腔静脉滤器。我们假设与普通创伤人群相比，孤立性 TBI 患者发生 PE 的风险不会增加。
分析了 2008 年国家创伤数据库中的患者数据。提取了患者的人口统计学、损伤严重程度评分以及深静脉血栓形成和 PE 的患病率。研究性损伤分为六大类：胸部、腹部实质器官、骨盆骨折、下肢骨折、脊柱骨折和 TBI。
在总共 627775 名受伤患者中，有 2182 名（0.35%）有记录的 PE。孤立性 TBI、下肢、骨盆骨折、肝/脾、胸部、脊柱、多发伤和无研究性损伤患者的 PE 患病率分别为 0.25%、0.36%、0.35%、0.37%、0.52%、0.37%、1.1%和 0.12%。使用年龄、性别和种族调整的多变量逻辑回归模型，并控制下腔静脉滤器和损伤类型之间的相互作用，我们发现孤立性 TBI 与 PE 无关。
与其他损伤相比，孤立性 TBI 似乎与 PE 的发生率增加无关。孤立性 TBI 患者可能不需要像其他高危人群那样早期积极预防。
