Fatal pulmonary thromboembolism.

OBJECTIVE: Venous thromboembolism is a complex, multifactorial disease, involving interactions between acquired or inherited predispositions to thrombosis and various risk factors, such as trauma and surgery. This study investigated the clinical features and most important risk factors of fatal pulmonary thromboembolism (PTE).

MATERIALS AND METHODS: Forensic records stored at the Council of Forensic Medicine, Ministry of Justice in Istanbul, Turkey, from January 2010 to December 2014 were screened for deaths of confirmed PTE based on autopsy or computed tomography (CT). Massive pulmonary embolism was the main cause of death in all patients.

RESULTS: The 51 cases with PTE comprised 22 (43.2%) males and 29 (56.8%) females. A diagnosis of PTE was established by autopsy in 76.6% (39/51) of the cases. Overall, 23 (45%) suffered multiple trauma and 14 (27.5%) underwent surgery. The mean time from surgery to death was 10.2 ±6.8 days. Of the trauma cases, 78% (18/23) comprised orthopaedic trauma. Death occurred in 74% of the cases after the second week following trauma. Of the trauma and surgery cases, 95.6 and 71.4% were outpatients at the time of death, respectively. The origin of the PTE was known in 34.8% and 57% of the trauma and surgery cases, respectively. The mean Injury Severity Score (ISS) was 11.3 ± 7.6. An abbreviated injury score (AIS) extremity ≥3 was seen in 23% (4/18) of the extremity trauma cases. The time to death of the patients who underwent surgery was shorter than in the patients who experienced trauma (p=0.001).

CONCLUSIONS: A high ISS is not a determinant of fatal PTE. Immobilization is important in the occurrence of PTE, especially in trauma patients. Frequent follow-up after discharge should inquire about complaints related to PTE and the use of protective precautions.