Department of General Medicine, Faculty of Medicine, Juntendo University, 2-1-2 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 270-0021, Japan.
Sci Rep. 2021 Sep 28;11(1):19192. doi: 10.1038/s41598-021-98692-4.
Post-trauma patients are at great risk of pulmonary embolism (PE), however, data assessing specific risk factors for post-traumatic PE are scarce. This was a nested case-control study using the Japan Trauma Data Bank between 2004 and 2017. We enrolled patients aged ≥ 16 years, Injury Severity Score ≥ 9, and length of hospital stay ≥ 2 days, with PE and without PE, using propensity score matching. We conducted logistic regression analyses to examine risk factors for PE. We included 719 patients with PE and 3595 patients without PE. Of these patients, 1864 [43.2%] were male, and their median Interquartile Range (IQR) age was 73 [55-84] years. The major mechanism of injury was blunt (4282 [99.3%]). Median [IQR] Injury Severity Score (ISS) was 10 [9-18]. In the multivariate analysis, the variables spinal injury [odds ratio (OR), 1.40 (1.03-1.89)]; long bone open fracture in upper extremity and lower extremity [OR, 1.51 (1.06-2.15) and OR, 3.69 (2.89-4.71), respectively]; central vein catheter [OR, 2.17 (1.44-3.27)]; and any surgery [OR, 4.48 (3.46-5.81)] were independently associated with PE. Spinal injury, long bone open fracture in extremities, central vein catheter placement, and any surgery were risk factors for post-traumatic PE. Prompt initiation of prophylaxis is needed for patients with such trauma.
创伤后患者发生肺栓塞（PE）的风险很高，然而，评估创伤后 PE 具体危险因素的数据却很少。这是一项 2004 年至 2017 年期间在日本创伤数据库中进行的嵌套病例对照研究。我们纳入了年龄≥16 岁、损伤严重程度评分（ISS）≥9 分和住院时间≥2 天的患者，采用倾向评分匹配法比较有 PE 和无 PE 的患者。我们进行了 logistic 回归分析以探讨 PE 的危险因素。共纳入 719 例 PE 患者和 3595 例无 PE 患者。其中 1864 例（43.2%）为男性，其中位数[四分位数间距（IQR）]年龄为 73[55-84]岁。主要损伤机制为钝性伤（4282 例[99.3%]）。ISS 的中位数[IQR]为 10[9-18]分。多变量分析显示，脊髓损伤[比值比（OR），1.40（1.03-1.89）]；上肢和下肢长骨开放性骨折[OR，1.51（1.06-2.15）和 OR，3.69（2.89-4.71）]；中心静脉置管[OR，2.17（1.44-3.27）]；以及任何手术[OR，4.48（3.46-5.81）]是与 PE 独立相关的因素。脊髓损伤、四肢长骨开放性骨折、中心静脉置管和任何手术是创伤后发生 PE 的危险因素。对于此类创伤患者，需要及时启动预防措施。
