Zeitschrift für Trauma und Behandlung

Does Deep Vein Thrombosis Usually Precede a Pulmonary Embolism

Abstract

Michael West, Joanie Wurster RN* and Joseph Kilch BA

Background: Trauma patients are at considerable risk for developing a Deep Vein Thrombosis [DVT] and subsequently experiencing a Pulmonary Embolism [PE], a process known as Venous Thromboembolism [VTE], which is a life-threatening complication that continues to be a major medical challenge.

Objective: To determine if a trauma patient who sustains a serious chest trauma as defined by the Abbreviated Injury Scale of 3 or more should be considered a high risk candidate for PE.

Method: This is a twelve-year retrospective study done at St. Mary’s Medical Center, a level II trauma center in West Palm Beach, FL, reviewing all trauma charts and autopsy reports of those patients who were diagnosed with PE, regardless of their mechanism of injury or initial diagnosis.

Results: A total of 18,451 patients were admitted to the trauma service during this time and 30 patients [0.16%] were diagnosed with a PE during their hospital stay or on autopsy. Among the 30 patients with a diagnosis of PE, 15 patients [50%] sustained chest trauma including diaphragmatic injuries, rib fractures, pneumothorax, and/or pulmonary contusion, and seven of those patients did not have a documented DVT. Among the 30 patients with PE, 18 [60%] did not have a detectable DVT.

Conclusion: This study supports the current literature that although DVTs are the most common cause of PE, severe chest trauma should be considered a significant contributing factor due to thrombi forming within the pulmonary vasculature.