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Clinical study| Volume 57, P46-50, November 2018

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Pulmonary embolism in severe traumatic brain injury

Published:August 25, 2018DOI:https://doi.org/10.1016/j.jocn.2018.08.042

      Highlights

      • Is Severe Traumatic Brain Injury (TBI) a Risk Factor for the Development of Pulmonary Embolism?
      • Why severe TBI is a risk factor for the development of PE?
      • What is the true incidence of PE in the context of severe TBI?
      • What are the implications that PE does have in severe TBI?
      • Should all severe TBI patients receive prophylaxis for DVT and PE?

      Abstract

      Introduction

      Pulmonary emboli (PE) is a significant source of morbidity and mortality in the trauma patients. The use of chemical prophylaxis to prevent deep venous thrombosis and subsequent PE is still controversial given its risk of increased intracranial hemorrhage expansion.

      Objective

      In the present study, we evaluated the incidence of PE in severe traumatic brain injury.

      Methods

      Retrospective review of patients who were admitted to a Neurosurgery unit from 2011 to 2013 with severe TBI who developed PE.

      Results

      155 patients met the study criteria. The incidence of PE was 2.58%. The cohort was mainly composed of white (71.6%), male (76.77%) with the mean age of 23.03 ± 15.79. There was no statistical difference between the patients who developed PE with prophylaxis and without (p = 0.58). Hospital length of stay was significantly increased by the development of a PE (27.82 ± 21.78 vs. 61.24 ± 25.74 days, p = 0.01).

      Conclusion

      Our data is limited by a low incidence of PE in this cohort, but does show an increased hospital length of stay. The true incidence of PE is unknown, so large-scale population studies are urgently needed and a high index of suspicion is required for diagnosis.

      Keywords

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      References

        • Rutland-Brown W.
        • Langlois J.A.
        • Thomas K.E.
        • Xi Y.L.
        Incidence of traumatic brain injury in the United States, 2003.
        J Head Trauma Rehab. 2006; 21: 544-548
        • Ma V.Y.
        • Chan L.
        • Carruthers K.J.
        Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pain.
        Arch Phys Med Rehabil. 2014; 95e1
        • Phelan H.A.
        Venous thromboembolism after traumatic brain injury.
        Semin Thromb Hemost. 2013; 39: 541-548
        • Phelan H.A.
        Pharmacologic venous thromboembolism prophylaxis after traumatic brain injury: a critical literature review.
        J Neurotrauma. 2012; 29: 1821-1828
        • Nyquist P.
        • Bautista C.
        • Jichici D.
        • Burns J.
        • Chhangani S.
        • DeFilippis M.
        • et al.
        Prophylaxis of venous thrombosis in neurocritical care patients: an evidence-based guideline: a statement for healthcare professionals from the neurocritical care society.
        Neurocrit Care. 2016; 24: 47-60
        • Maegele M.
        • Schöchl H.
        • Menovsky T.
        • Maréchal H.
        • Marklund N.
        • Buki A.
        • et al.
        Coagulopathy and haemorrhagic progression in traumatic brain injury: advances in mechanisms, diagnosis, and management.
        Lancet Neurol. 2017; 16: 630-647
        • Geerts W.H.
        • Code K.I.
        • Jay R.M.
        • Chen E.
        • Szalai J.P.
        A prospective study of venous thromboembolism after major trauma.
        N Eng J Med. 1994; 331: 1601-1606
        • Soo Hoo G.W.
        Overview and assessment of risk factors for pulmonary embolism.
        Expert Rev Respir Med. 2013; 7: 171-191
        • Godbolt A.K.
        • Stenberg M.
        • Jakobsson J.
        • Sorjonen K.
        • Krakau K.
        • Stålnacke B.M.
        • et al.
        Subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome.
        BMJ Open. 2015; 5e007208
        • Knudson M.M.
        • Ikossi D.G.
        • Khaw L.
        • Morabito D.
        • Speetzen L.S.
        Thromboembolism after trauma: an analysis of 1602 episodes from the American College of Surgeons National Trauma Data Bank.
        Ann Surg. 2004; 240: 490-496
        • Denson K.
        • Morgan D.
        • Cunningham R.
        • Nigliazzo A.
        • Brackett D.
        • Lane M.
        • et al.
        Incidence of venous thromboembolism in patients with traumatic brain injury.
        Am J Surg. 2007; 193: 380-384
        • Bahloul M.
        • Chelly H.
        • Regaieg K.
        • Rekik N.
        • Bellil S.
        • Chaari A.
        • et al.
        Pulmonary embolism following severe traumatic brain injury: incidence, risk factors and impact outcome.
        Intensive Care Med. 2017; 43: 1433-1435
        • Praeger A.J.
        • Westbrook A.J.
        • Nichol A.D.
        • Wijemunige R.
        • Davies A.R.
        • Lyon S.M.
        • et al.
        Deep vein thrombosis and pulmonary embolus in patients with traumatic brain injury: a prospective observational study.
        Crit Care Resusc. 2012; 14: 10-13
        • Khaldi A.
        • Helo N.
        • Schneck M.J.
        • Origitano T.C.
        Venous thromboembolism: deep venous thrombosis and pulmonary embolism in a neurosurgical population.
        J Neurosurg. 2011; 114: 40-46
        • Skrifvars M.B.
        • Bailey M.
        • Presneill J.
        • French C.
        • Nichol A.
        • Little L.
        • et al.
        investigators and the ANZICS Clinical Trials Group. Venous thromboembolic events in critically ill traumatic brain injury patients.
        Intensive Care Med. 2017; 43: 419-428
        • Scudday T.
        • Brasel K.
        • Webb T.
        • et al.
        Safety and efficacy of prophylactic anticoagulation in patients with traumatic brain injury.
        J Am Coll Surg. 2011; 213 ([discussion 53-4]): 148-153
        • Saadeh Y.
        • Gohil K.
        • Bill C.
        • et al.
        Chemical venous thromboembolic prophylaxis is safe and effective for patients with traumatic brain injury when started 24 hours after the absence of hemorrhage progression on head CT.
        J Trauma Acute Care Surg. 2012; 73: 426-430
        • Farooqui A.
        • Hiser B.
        • Barnes S.
        • et al.
        Safety and efficact of early thromboembolism chemoprophylaxis after intracranial hemorrhage from traumatic brain injury.
        J Neurosurg. 2013; 119: 1576-1582
        • Mohseni S.
        • Talving P.
        • Lam L.
        • et al.
        Venous thromboembolism events in isolated severe traumatic brain injury.
        J Emerg Trauma Shock. 2012; 5: 11-15
        • Raychaudhuri R.
        • Litofsky N.S.
        Which traumatic brain injury patients should be treated with anticoagulants and when?.
        Expert Rev Neurother. 2014; 14: 237-239
        • Dengler B.A.
        • Mendez-Gomez P.
        • Chavez A.
        • Avila L.
        • Michalek J.
        • Hernandez B.
        • et al.
        Safety of chemical DVT prophylaxis in severe traumatic brain injury with invasive monitoring devices.
        Neurocrit Care. 2016; 25: 215-223
        • Agnelli G.
        • Becattini C.
        Acute pulmonary embolism.
        N Eng J Med. 2010; 363: 266-274
        • Maegele M.
        Coagulopathy after traumatic brain injury: incidence, pathogenesis, and treatment options.
        Tranfusion. 2013; 53: 28S-37S
        • Epstein D.
        • Mitra B.
        • O’Reilly G.
        • Rosenfeld J.V.
        • Cameron P.A.
        Acute traumatic coagulopathy in the setting of isolated traumatic brain injury: a systematic review and meta-analysis DARE Injury.
        Int J Care Injured. 2014; 45: 819-824
        • Laroche M.
        • Kutcher M.E.
        • Huang M.C.
        • Cohen M.J.
        • Manley G.T.
        Coagulopathy after traumatic brain injury.
        Neurosurgery. 2012; 70: 1334-1345
        • De Oliveira Manoel A.L.
        • Capone Neto A.
        • Veigas P.V.
        • Rizoli S.
        Traumatic brain injury associated coagulopathy.
        Neurocrit Care. 2014; 22: 1-12
        • Carney N.
        • Totten A.M.
        • O’Reilly C.
        • Ullman J.S.
        • Hawryluk G.W.
        • Bell M.J.
        • et al.
        Guidelines for the management of severe traumatic brain injury, Fourth Edition.
        Neurosurgery. 2017; 80: 6-15
        • Jeremitsky E.
        • St Germain N.
        • Kao A.H.
        • Ong A.W.
        • Smith R.S.
        Risk of pulmonary embolism in trauma patients: not all created equal.
        Surgery. 2013; 154: 810-814