Risk scoring models fail to predict pulmonary embolism in trauma patients

Frank R Buchanan; Emily Leede; Lawrence H Brown; Pedro G Teixeira; Jayson D Aydelotte; Tatiana C Cardenas; Thomas B Coopwood; Marc D Trust; Sadia Ali; Carlos V R Brown

doi:10.1016/j.amjsurg.2021.02.007

Risk scoring models fail to predict pulmonary embolism in trauma patients

Am J Surg. 2021 Oct;222(4):855-860. doi: 10.1016/j.amjsurg.2021.02.007. Epub 2021 Feb 11.

Authors

Affiliations

¹ Department of Surgery and Perioperative Care, Dell Seton Medical Center at the University of Texas, 1500 Red River St, Austin, TX, 78701, USA. Electronic address: [email protected].
² Department of Surgery and Perioperative Care, Dell Seton Medical Center at the University of Texas, 1500 Red River St, Austin, TX, 78701, USA. Electronic address: [email protected].
³ Department of Surgery and Perioperative Care, Dell Seton Medical Center at the University of Texas, 1500 Red River St, Austin, TX, 78701, USA. Electronic address: [email protected].
⁴ Department of Surgery and Perioperative Care, Dell Seton Medical Center at the University of Texas, 1500 Red River St, Austin, TX, 78701, USA. Electronic address: [email protected].
⁵ Department of Surgery and Perioperative Care, Dell Seton Medical Center at the University of Texas, 1500 Red River St, Austin, TX, 78701, USA. Electronic address: [email protected].
⁶ Department of Surgery and Perioperative Care, Dell Seton Medical Center at the University of Texas, 1500 Red River St, Austin, TX, 78701, USA. Electronic address: [email protected].
⁷ Department of Surgery and Perioperative Care, Dell Seton Medical Center at the University of Texas, 1500 Red River St, Austin, TX, 78701, USA. Electronic address: [email protected].
⁸ Department of Surgery and Perioperative Care, Dell Seton Medical Center at the University of Texas, 1500 Red River St, Austin, TX, 78701, USA. Electronic address: [email protected].
⁹ Department of Surgery and Perioperative Care, Dell Seton Medical Center at the University of Texas, 1500 Red River St, Austin, TX, 78701, USA. Electronic address: [email protected].
¹⁰ Department of Surgery and Perioperative Care, Dell Seton Medical Center at the University of Texas, 1500 Red River St, Austin, TX, 78701, USA. Electronic address: [email protected].

PMID: 33608103
DOI: 10.1016/j.amjsurg.2021.02.007

Abstract

Background: We aimed to identify risk factors and risk scoring models to help identify post-traumatic pulmonary embolisms (PE).

Methods: We performed a retrospective review (2014-2019) of all adult trauma patients admitted to our Level I trauma center that received a CT pulmonary angiogram (CTPA) for a suspected PE. A systematic literature search found eleven risk scoring models, all of which were applied to these patients. Scores of patients with and without PE were compared.

Results: Of the 235 trauma patients that received CTPA, 31 (13%) showed a PE. No risk scoring model had both a sensitivity and specificity above 90%. The Wells Score had the highest area under the curve (0.65). After logistic regression, no risk scoring model variables were independently associated with PE.

Conclusions: In trauma patients with clinically suspected PE, clinical variables and current risk scoring models do not adequately differentiate patients with and without PE.

Keywords: Embolism; Prediction; Pulmonary; Risk; Score; Trauma.

MeSH terms

Female
Humans
Male
Middle Aged
Predictive Value of Tests
Pulmonary Embolism / etiology*
Retrospective Studies
Risk Assessment
Risk Factors
Sensitivity and Specificity
Wounds and Injuries / complications*