(1540) High Rate of Pulmonary Embolism in Internationally Transferred Trauma Patients

Sunday, January 21, 2024

11:00 AM – 12:00 PM MT

Location: Connections Central - RST 17

First Author(s)

Luciana Tito Bustillos, MD, (she/her/hers)

Research Scholar, MD
University of Miami Leonard M Miller School of Medicine
Miami, Florida

Co-Author(s)

BC

Brianna L. Collie, MD

Doctor
Dewitt Daughtry Family Department of Surgery -University of Miami/Jackson Memorial Hospital, United States
NL

Nicole B. Lyons, MD

Doctor
Dewitt Daughtry Family Department of Surgery -University of Miami/Jackson Memorial Hospital, United States
WR

Walter A. Ramsey, MD

Doctor
Dewitt Daughtry Family Department of Surgery -University of Miami/Jackson Memorial Hospital, United States
CO

Christopher F. O’Neil, MD

Doctor
Dewitt Daughtry Family Department of Surgery -University of Miami/Jackson Memorial Hospital, United States
JD

Jessica M. Delamater, MD

Doctor
Dewitt Daughtry Family Department of Surgery -University of Miami/Jackson Memorial Hospital, United States
MC

Michael D. Cobler-Lichter, MD

Doctor
Dewitt Daughtry Family Department of Surgery -University of Miami/Jackson Memorial Hospital, United States
LS

Larisa Shagabayeva, MD

Doctor
Dewitt Daughtry Family Department of Surgery -University of Miami/Jackson Memorial Hospital, United States
EG

Enrique Ginzburg, MD

Professor of Surgery
University of Miami Leonard M Miller School of Medicine, United States
JM

Jonathan Meizoso, MD

Assistant Professor of Surgery
Dewitt Daughtry Family Department of Surgery -University of Miami/Jackson Memorial Hospital, United States
KP

Kenneth G. Proctor, PhD

Professor of Surgery
Dewitt Daughtry Family Department of Surgery -University of Miami/Jackson Memorial Hospital, United States
Brandon M. M. Parker, DO

Assistant Professor of Surgery
Dewitt Daughtry Family Department of Surgery -University of Miami/Jackson Memorial Hospital, United States
NN

Nicholas Namias, MBA, MD, FCCM

Professor of Surgery
Dewitt Daughtry Family Department of Surgery -University of Miami/Jackson Memorial Hospital, United States
Gerd D. Pust, MD, FACS

Associate Professor of Surgery
Dewitt Daughtry Family Department of Surgery -University of Miami/Jackson Memorial Hospital
Miami, Florida, United States

Introduction:

Introduction: Post-traumatic pulmonary embolism (PE) is the third most common cause of death in patients that survive the initial 24 hours after injury. The incidence of PE varies from 0.11% to 2.3% in trauma patients overall, however recent studies show an increased risk of PE in transfer patients. We hypothesize that internationally transferred trauma patients with a prolonged transfer time have a higher prevalence of PEs compared to local transfers and non-transferred trauma patients.

Methods:

Methods: Retrospective review of all international transfer trauma patients who presented to a level I trauma center from 1/2018 to 6/2023. Primary outcome was an incidental finding of a PE on CT scan completed as part of the initial trauma workup. Data were compared with univariate analyses with statistical significance set at p < 0.05.

Results:

Results: There were 593 international transfer trauma patients, of which 252 (42%) received a CTA chest. The average age was 47 [31-65], 74% were male. The median time since injury was 1 day [0-2]. In total, 9.9% of internationally transferred patients had a PE on CTA chest compared to 0.45% PE rate in local transfers in a national sample of trauma patients (p < 0.001). In our sample, patients with PE had a significantly longer days from injury (1 vs 1.50, p=0.033). However, there was no difference in ISS (16 vs 14, p=0.988), age (47yr vs 50yr, p=0.94) or GCS (12 vs 12, p=0.64) between those that did and those that did not have a PE.

Conclusions:

Conclusions: To our knowledge, this is the first study to show that the rate of incidental PE on CTA chest in international transfer trauma patients is considerably higher than local trauma transfers. This is likely due to a longer time interval between injury occurrence and definitive trauma center arrival. Initiation of a new protocol in conjunction with referring hospitals is warranted to initiate early DVT prophylaxis in the absence of contraindications prior to air transportation.