Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Eur J Trauma Emerg Surg. 2023 Aug;49(4):1959-1967. doi: 10.1007/s00068-023-02290-0. Epub 2023 Jun 7.
Trauma patients are at high risk of Venous thromboembolism (VTE), but compared to well-established deep venous thrombosis (DVT), data specifically evaluating post-traumatic pulmonary embolism (PE) are scarce. The aim of this study is to assess whether PE represents a distinct clinical entity with injury pattern, risk factors, and prophylaxis strategy different from DVT, among severe poly-trauma patients.
We retrospectively enrolled patients admitted to our level I trauma center from January 2011 to December 2021 who were diagnosed with severe multiple traumatic injuries and identified thromboembolic events among them. We regarded four groups as None (without thromboembolic events), DVT only, PE only, and PE with DVT. Demographics, injury characteristics, clinical outcomes, and treatments were collected and analyzed in individual groups. Patients were also classified according to the occurring time of PE, and indicative symptoms and radiological findings were compared between early PE (≤ 3 days) and late PE (> 3 days). Logistic regression analyses were conducted to explore independent risk factors for different VTE patterns.
Among 3498 selected severe multiple traumatic patients, there were 398 episodes of DVT only, 19 of PE only, and 63 of PE with DVT. Injury variables associated with PE only included shock on admission and severe chest trauma. Severe pelvic fracture and mechanical ventilator days (MVD) ≥ 3 were the independent risk factors for PE with DVT. There were no significant differences in the indicative symptoms and location of pulmonary thrombi between the early and late PE groups. Obesity and severe lower extremity injury might have an impact on the incidence of early PE, while patients with a severe head injury and higher ISS are particularly at risk for developing late PE.
Occurring early, lacking association with DVT, and possessing distinct risk factors warrant PE in severe poly-trauma patients special attention, especially for its prophylaxis strategy.
创伤患者有发生静脉血栓栓塞症（VTE）的高风险，但与已确立的深静脉血栓形成（DVT）相比，专门评估创伤后肺栓塞（PE）的数据仍然缺乏。本研究旨在评估严重多发伤患者中，PE 是否代表一种具有不同损伤模式、风险因素和预防策略的独特临床实体，与 DVT 不同。
我们回顾性纳入了 2011 年 1 月至 2021 年 12 月期间我院收治的严重多发伤患者，这些患者均被诊断为严重多发伤且其中发生了血栓栓塞事件。我们将患者分为 4 组：无血栓栓塞事件组（None）、仅有 DVT 组、仅有 PE 组和同时存在 DVT 和 PE 组。我们收集和分析了各组的人口统计学、损伤特征、临床结局和治疗情况。患者还根据 PE 的发生时间进行分类，并比较了早期 PE（≤3 天）和晚期 PE（>3 天）的症状和影像学表现。我们进行了 logistic 回归分析，以探讨不同 VTE 模式的独立危险因素。
在 3498 例严重多发伤患者中，有 398 例仅有 DVT、19 例仅有 PE 和 63 例同时存在 DVT 和 PE。仅有 PE 组的损伤变量包括入院时休克和严重胸部创伤。严重骨盆骨折和机械通气天数（MVD）≥3 是同时存在 DVT 和 PE 的独立危险因素。早期和晚期 PE 组的肺部血栓的症状和位置无显著差异。肥胖和严重下肢损伤可能会影响早期 PE 的发生率，而严重头部损伤和较高的 ISS 患者发生晚期 PE 的风险较高。
PE 在严重多发伤患者中发生较早、与 DVT 无关且具有独特的危险因素，需要特别关注，尤其是其预防策略。
