The silent killer: Previously undetected pulmonary emboli that result in death after discharge

•There is limited information about the incidence of fatal PE after discharge.•This study elucidates risk factors for fatal PE after discharge.•Mobility-limiting injuries are an indication for venous thromboembolism prophylaxis until recovery. Pulmonary embolism (PE) is a recognized cause of death i...

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Published inInjury Vol. 54; no. 11; p. 111016
Main Authors Kalkwarf, Kyle J., Yang, Yijiong, Mora, Stephen, Wolf, Dwayne A., Robertson, Ronald D., Holcomb, John B., Drake, Stacy A.
Format Journal Article
LanguageEnglish
Published Elsevier Ltd 01.11.2023
Subjects
Anticoagulation
Antiplatelet
Autopsy
DVT
Fracture
Pulmonary emboli
Thromboembolism
Trauma
VTE prophylaxis
Pulmonary emboli
Antiplatelet
DVT
VTE prophylaxis
Autopsy
Anticoagulation
Fracture
Thromboembolism
Trauma
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Summary:•There is limited information about the incidence of fatal PE after discharge.•This study elucidates risk factors for fatal PE after discharge.•Mobility-limiting injuries are an indication for venous thromboembolism prophylaxis until recovery. Pulmonary embolism (PE) is a recognized cause of death in hospitalized trauma patients, yet less is known about PE after discharge. All post-discharge, autopsy-demonstrated, fatal PE resulting from trauma within a large US county over six years were analyzed. Counts, percentages, mean values, SD, and IQR were calculated for all variables. 1848 trauma deaths were reviewed, of which 85% had an autopsy. Eighty-five patients died from PE after discharge from their initial injury. 53% were initially treated at non-trauma centers, and 9% did not seek medical assistance. 75% were injured by falling, and most injuries occurred in the lower extremities. 86% had an ISS <16, but 87% needed assistance or were bed-bound after injury, despite 75% having no mobility limitations before the injury. 53% died within one month of injury, and 91% within the first year. Before death, only 11% were prescribed chemical thromboprophylaxis or an antiplatelet agent, and only 8% were diagnosed with venous thromboembolism before death. Fatal PE after discharge typically occurred following activity-limiting lower extremity injuries with an ISS<16.
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ISSN:0020-1383
1879-0267
DOI:10.1016/j.injury.2023.111016