Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, CA, USA.
Department of Surgery, Grady Memorial Hospital, Emory University, Glenn Memorial Building, 3rd Flr, 69 Jesse Hills Jr Dr SE, Atlanta, GA, 30303, USA.
Eur J Trauma Emerg Surg. 2023 Feb;49(1):241-251. doi: 10.1007/s00068-022-02044-4. Epub 2022 Jul 14.
Studies in non-trauma populations have shown that Black patients have a higher risk of venous thromboembolism (VTE) compared to other races. We sought to determine whether this association exists in trauma patients. The incidence of VTE is particularly high following severe pelvic fractures. To limit confounding factors associated with additional injuries, we examined patients with isolated blunt severe pelvic fractures.
The TQIP database (2013-2017) was queried for all patients who sustained isolated blunt severe pelvic fractures (AIS ≥ 3) and received VTE prophylaxis (VTEp) with either unfractionated heparin or low molecular weight heparin. The study groups were Asian, Black, and White race as defined by TQIP. The primary outcome was differences in the rate of thromboembolic events.
A total of 9491 patients were included in the study. Of these, 232 (2.4%) were Asian, 1238 (13.0%) Black, and 8021 (84.5%) White. There was no significant difference in the distribution of pelvis AIS 3,4,5 between the groups. Black patients had a significantly higher incidence of VTE, DVT and PE compared to Asians and Whites. After adjusting for differences between the groups, Black patients had higher odds of developing pulmonary embolism (OR 1.887, 95% CI 1.101-3.232, p = 0.021) compared to White patients.
In this nationwide study of trauma patients with severe pelvic fractures, Black patients were more likely to develop pulmonary embolism compared to White patients. Further research to identify the determinants of racial disparities in trauma-related VTE is warranted, to target interventions that can improve VTE outcomes for all patients.
非创伤人群的研究表明，与其他种族相比，黑种人患静脉血栓栓塞症（VTE）的风险更高。我们试图确定这种关联是否存在于创伤患者中。VTE 的发病率在严重骨盆骨折后尤其高。为了限制与其他损伤相关的混杂因素，我们检查了单纯性钝性严重骨盆骨折患者。
TQIP 数据库（2013-2017 年）被查询用于所有发生单纯性钝性严重骨盆骨折（AIS≥3）并接受未分级肝素或低分子肝素 VTE 预防（VTEp）的患者。研究组按 TQIP 定义为亚洲人、黑人和白人。主要结果是血栓栓塞事件发生率的差异。
共有 9491 名患者纳入研究。其中，232 名（2.4%）为亚洲人，1238 名（13.0%）为黑人，8021 名（84.5%）为白人。三组间骨盆 AIS 3、4、5 的分布无显著差异。黑人患者 VTE、DVT 和 PE 的发生率明显高于亚洲人和白人。调整组间差异后，黑人患者发生肺栓塞的几率高于白人（OR 1.887，95%CI 1.101-3.232，p=0.021）。
在这项针对严重骨盆骨折创伤患者的全国性研究中，与白人患者相比，黑人患者更易发生肺栓塞。需要进一步研究确定创伤相关 VTE 种族差异的决定因素，以针对所有患者改善 VTE 结局的干预措施。
