Document Detail

Pulmonary embolism and deep venous thrombosis in trauma: are they related?
MedLine Citation:
PMID:  19841360     Owner:  NLM     Status:  MEDLINE    
HYPOTHESIS: Pulmonary embolism (PE) and deep venous thrombosis (DVT) in trauma are related. DESIGN: Retrospective review of medical records. SETTING: Academic level I trauma center. PATIENTS: Trauma patients who underwent computed tomographic pulmonary angiography (CTPA) with computed tomographic venography (CTV) of the pelvic and proximal lower extremity veins over a 3-year period (January 1, 2004, to December 31, 2006) were reviewed. Data on demographics, injury type and severity, imaging findings, hospital length of stay, and mortality were collected. MAIN OUTCOME MEASURES: Pulmonary embolism and DVT. RESULTS: Among 247 trauma patients undergoing CTPA/CTV, PE was diagnosed in 46 (19%) and DVT in 18 (7%). Eighteen PEs were central (main or lobar pulmonary arteries), and 28 PEs were peripheral (segmental or subsegmental branches). Pulmonary embolism occurred within the first week of injury in two-thirds of patients. Seven patients with PE (4 femoral, 2 popliteal, and 1 iliac) had DVT. Pulmonary embolism was central in 5 patients and peripheral in 2 patients. No significant differences were noted in any of the examined variables between patients with PE having DVT and those not having DVT. CONCLUSIONS: Few patients with PE have DVT of the pelvic or proximal lower extremity veins. Pulmonary embolism may not originate from these veins, as commonly believed, but instead may occur de novo in the lungs. These findings have implications for thromboprophylaxis and, particularly, the value of vena cava filters.
George C Velmahos; Konstantinos Spaniolas; Malek Tabbara; Hani H Abujudeh; Marc de Moya; Alice Gervasini; Hasan B Alam
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of surgery (Chicago, Ill. : 1960)     Volume:  144     ISSN:  1538-3644     ISO Abbreviation:  Arch Surg     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-20     Completed Date:  2009-12-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9716528     Medline TA:  Arch Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  928-32     Citation Subset:  AIM; IM    
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge St, Ste 810, Boston, MA 02114, USA.
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MeSH Terms
Anticoagulants / therapeutic use
Cohort Studies
Middle Aged
Pulmonary Embolism / diagnosis,  epidemiology*,  therapy
Retrospective Studies
Risk Factors
Severity of Illness Index
Tomography, X-Ray Computed
Vena Cava Filters
Venous Thrombosis / diagnosis,  epidemiology*,  therapy
Wounds and Injuries / complications*,  radiography,  therapy
Reg. No./Substance:
Comment In:
Arch Surg. 2009 Oct;144(10):932   [PMID:  19852101 ]

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