TY - JOUR
T1 - Incidence of pulmonary embolus in combat casualties with extremity amputations and fractures
AU - Gillern, Suzanne M.
AU - Sheppard, Forest R.
AU - Evans, Korboi N.
AU - Graybill, J. Christopher
AU - Gage, Frederick A.
AU - Forsberg, Jonathan A.
AU - Dunne, James R.
AU - Tadaki, Douglas K.
AU - Elster, Eric A.
PY - 2011/9
Y1 - 2011/9
N2 - BACKGROUND:: The objective of this retrospective study was to determine the incidence of pulmonary embolism (PE) in casualties of wartime extremity wounds and specifically in casualties with a trauma-associated amputation. METHODS:: Records of all combat-wounded evacuated and admitted between March 1, 2003, and December 31, 2007, were retrospectively reviewed. Continuous and categorical variables were studied with the Student's t test, Fisher's exact test or χ test; multivariate analysis was performed using a stepwise regression logistic model. RESULTS:: A total of 1,213 records were reviewed; 263 casualties met the inclusion criteria. One hundred three (41.5%) had amputations and 145 (58.5%) had long-bone fractures not requiring amputation. The observed rate of PE in these 263 casualties was 5.7%. More casualties with amputations, 10 (3.7%), developed PE than those with long-bone fractures in the absence of amputation, 5 (1.9%) (p = 0.045). Casualties with bilateral lower extremity trauma-associated amputations had a significantly higher incidence of PE compared with those sustaining a single amputation (p = 0.023), and the presence of bilateral lower extremity amputations was an independent risk factor for development of a PE (p = 0.007, odds ratio 5.9) (univariate and multivariate analysis, respectively). CONCLUSION:: The cumulative incidence of PE was 5.7%. The incidence of PE is significantly higher with trauma-associated amputation than with extremity long-bone fracture without amputation. Bilateral amputations, multiple long-bone fractures, and pelvic fractures are independent risk factors for the development of PE. The use of aggressive prophylaxis, deep venous thrombosis screening with ultrasound, and use of prophylactic inferior vena cava filters should be considered in this patient population.
AB - BACKGROUND:: The objective of this retrospective study was to determine the incidence of pulmonary embolism (PE) in casualties of wartime extremity wounds and specifically in casualties with a trauma-associated amputation. METHODS:: Records of all combat-wounded evacuated and admitted between March 1, 2003, and December 31, 2007, were retrospectively reviewed. Continuous and categorical variables were studied with the Student's t test, Fisher's exact test or χ test; multivariate analysis was performed using a stepwise regression logistic model. RESULTS:: A total of 1,213 records were reviewed; 263 casualties met the inclusion criteria. One hundred three (41.5%) had amputations and 145 (58.5%) had long-bone fractures not requiring amputation. The observed rate of PE in these 263 casualties was 5.7%. More casualties with amputations, 10 (3.7%), developed PE than those with long-bone fractures in the absence of amputation, 5 (1.9%) (p = 0.045). Casualties with bilateral lower extremity trauma-associated amputations had a significantly higher incidence of PE compared with those sustaining a single amputation (p = 0.023), and the presence of bilateral lower extremity amputations was an independent risk factor for development of a PE (p = 0.007, odds ratio 5.9) (univariate and multivariate analysis, respectively). CONCLUSION:: The cumulative incidence of PE was 5.7%. The incidence of PE is significantly higher with trauma-associated amputation than with extremity long-bone fracture without amputation. Bilateral amputations, multiple long-bone fractures, and pelvic fractures are independent risk factors for the development of PE. The use of aggressive prophylaxis, deep venous thrombosis screening with ultrasound, and use of prophylactic inferior vena cava filters should be considered in this patient population.
KW - Pulmonary embolus
KW - War
KW - Wounds, Combat
UR - http://www.scopus.com/inward/record.url?scp=80052766851&partnerID=8YFLogxK
U2 - 10.1097/TA.0b013e3182282574
DO - 10.1097/TA.0b013e3182282574
M3 - Article
C2 - 21908998
AN - SCOPUS:80052766851
SN - 0022-5282
VL - 71
SP - 607
EP - 612
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 3
ER -