Neurosurgical Resident UTHSCSA San Antonio, Texas, United States
Introduction: Pulmonary embolism (PE) causes significant morbidity and mortality. Knowing the incidence and factors contributing to PE in traumatic brain injury (TBI) can better control outcomes. We aim to find the incidence of PE in TBI and the association of comorbidities with the development of PE.
Methods: Retrospective cross-sectional study of TBI patients in the United States (US) between 2016-2020 collected from Nationwide Inpatient Sample. The cohort was dichotomized (presence or absence of PE), and evaluated for demographics, TBI sub-types, and comorbidities. Regression statistical analysis was conducted to find the odds of developing PE in TBI, with P< 0.05 being significant.
Results: From our cohort there were 1,033,540 TBI cases, of which 6,620 developed PE (0.65%) and 3584 developed DVT (1.8%). Main cohort characteristics were white (71.5%), male (60%), mean age of 64.8y/o, and with mostly subdural hematoma TBI (49.3%). Patients who developed PE were younger (61.1 vs. 64.9, p< 0.001), male (66.9%, p< 0.001), had increased LOS (18.4 vs 6.9d, p< 0.001), significantly higher mortality (13,7% vs. 8.1, p< 0.001), and worse adverse discharge disposition (69.9% vs 46.2%, p< 0.001).
In multivariate regression, presence of DVT (OR-9.85, 95% CI[5.5-17.6], p< 0.001), respiratory disease (OR-1.33, 95% CI[1.08-1.64], p=0.009), renal disease (OR-1.3, 95% CI[1.3-1.5], p< 0.001) and black race (OR-1.27, 95% CI[1.07-1.5], p=0.006) had the highest impact on developing PE. Of the different TBI sub-types, epidural hematoma had the most association with developing PE (OR-1.43, 95% CI[1.01-2.02], p=0.04).
Conclusion : Our data shows the incidence of PE in TBI in the US is low, but associated with significant mortality and high LOS. The incidence of PE is higher in Blacks and those with DVT, respiratory disease, and renal failure. Among different TBI sub-types, epidural hematoma has the highest association with PE. Further studies are warranted to find the association of TBI sub-types with development of PE.
