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Original article
Pulmonary embolism following complex trauma: UK MTC observational study
  1. Thomas E Glover1,
  2. Joanna E Sumpter1,
  3. Ari Ercole1,2,
  4. Virginia F J Newcombe1,2,
  5. Andrea Lavinio1,
  6. Andrew D Carrothers3,
  7. David K Menon1,2,
  8. Ronan O’Leary1
  1. 1 Neurosciences and Trauma Critical Care Unit, Cambridge University Hospitals, Cambridge, UK
  2. 2 University Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
  3. 3 Orthopaedic Trauma Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Dr Ronan O’Leary, Neurosciences and Trauma Critical Care Unit, Cambridge University Hospitals, Cambridge CB2 0QQ, UK; mail{at}ronanoleary.net

Abstract

Objectives To describe the incidence of pulmonary embolism (PE) in a critically ill UK major trauma centre (MTC) patient cohort.

Methods A retrospective, multidataset descriptive study of all trauma patients requiring admission to level 2 or 3 care in the East of England MTC from 1 November 2014 to 1 May 2017. Data describing demographics, the nature and extent of injuries, process of care, timing of PE prophylaxis, tranexamic acid (TXA) administration and CT scanner type were extracted from the Trauma Audit and Research Network database and hospital electronic records. PE presentation was categorised as immediate (diagnosed on initial trauma scan), early (within 72 hours of admission but not present initially) and late (diagnosed after 72 hours).

Results Of the 2746 trauma patients, 1039 were identified as being admitted to level 2 or 3 care. Forty-eight patients (4.6%) were diagnosed with PE during admission with 14 immediate PEs (1.3%). Of 32.1% patients given TXA, 6.3% developed PE compared with 3.8% without TXA (p=0.08).

Conclusion This is the largest study of the incidence of PE in UK MTC patients and describes the greatest number of immediate PEs in a civilian complex trauma population to date. Immediate PEs are a rare phenomenon whose clinical importance remains unclear. Tranexamic acid was not significantly associated with an increase in PE in this population following its introduction into the UK trauma care system.

  • pulmonary embolism
  • trauma
  • major trauma management
  • Ct/mri

https://doi.org/10.1136/emermed-2018-208372

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    Footnotes

    • Contributors TEG: planned the study, did the literature search, undertook the data collection and analysis, contributed to the manuscript preparation. JES: undertook the data collection. AE: undertook the data analysis, contributed to the manuscript preparation. VFJN: assisted with data collection, participated in the manuscript preparation. AL: contributed to manuscript preparation and critical revision of the final draft. ADC: contributed to manuscript preparation and critical revision of the final draft. DKM: aided with study design, critical revision of the final draft of the manuscript. ROL: planned the study, jointly did the literature search and review, participated in data analysis and interpretation, manuscript preparation, project supervision and overall responsibility.

    • Funding DKM is supported by the Cambridge Biomedical Research Centre National Institute for Health Research (UK) and by a European Union FP7 Grant to the CENTER-TBI study. VFJN is supported by an Academy of Medical Sciences/The Health Foundation Clinician Scientist Fellowship.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.