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

Abstract

Introduction: Pulmonary embolism (PE) is a recognized cause of death in hospitalized trauma patients, yet less is known about PE after discharge.

Patients & methods: 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.

Results: 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.

Conclusions: Fatal PE after discharge typically occurred following activity-limiting lower extremity injuries with an ISS<16.

Keywords: Anticoagulation; Antiplatelet; Autopsy; DVT; Fracture; Pulmonary emboli; Thromboembolism; Trauma; VTE prophylaxis.