Post-traumatic thrombo-embolic complications in polytrauma patients

作者：Lichte Philipp^*; Kobbe Philipp; Almahmoud Khalid; Pfeifer Roman; Andruszkow Hagen; Hildebrand Frank; Lefering Rolf; Pape Hans Christoph

来源：International Orthopaedics, 2015, 39(5): 947-954.

DOI：10.1007/s00264-015-2698-6

• Polytrauma
• Embolic complication
• Risk factor

Introduction Thrombo-embolic events after trauma are considered to be life-threatening complications. Our aim was to determine the incidence of arterial and venous thrombo-embolic events (TE) in severely-injured trauma patients, and its associated risk factors by using a large trauma registry.
Methods Patients' data from the TraumaRegister DGUA (R) (TR-DGU) were screened for TE (DVT [symptomatic deep vein thrombosis], PE [symptomatic pulmonary embolism], MI [myocardial infarction], and stroke) through the clinical course of severely injured adult trauma patients from January 2005 to December 2012. Univariate analysis was used to compare the clinical outcomes (endpoints: mortality, ICU and hospital length of stay, ventilator days), and a multivariate regression analysis was used to assess the independent risk factors associated with each TE event.
Results From a cohort of 40,846 trauma patients, 1122 (2.8 %) patients developed a TE during their post-traumatic clinical course (313, 0.8 % DVT; 425, 1.0 % PE; 160, 0.4 % MI and 231, 0.6 % stroke). ICU length of stay [LOS], total LOS, days on mechanical ventilation, and incidence of multiple organ failure (MOF) and sepsis were significantly increased in patients with TE complications. Injury severity, major pelvic injury, and one or more operations were found to be independent risk factors for the development of DVT. Age a parts per thousand yenaEuro parts per thousand 60 years, male gender, and more than one operation were risk factors for PE development. For MI age was the only significant risk factor. The occurrence of a stroke is increased in patients with an age a parts per thousand yenaEuro parts per thousand 60 years, major head injury (AIS head a parts per thousand yenaEuro parts per thousand 3), and more than one operation. Finally, mortality rates were significantly higher in the TE group when compared to the non-TE cohort (21.8 % vs. 12.7 %; p < 0.001).
Conclusion TE complications were associated with longer ICU and hospital stay as well as a higher mortality. Overall, age and repeated operations were the most important risk factors for the development of TE events.

• 出版日期2015-5