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Thank you for attending THSNA 2026. The virtual meeting is now closed.
Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| Risk and Outcomes of Pulmonary Embolism in Trauma-Associated Hospitalizations Among Individuals with Sickle Cell Disease (THSNA �Travel Awardee) Ayobami Olafimihan1, Victoria Ojukwu2, Lewis Hsu3. 1John H Stroger Hospital of Cook County, Chicago, IL, USA.2UChealth Parkview Medical Center, Pueblo, CO, USA.3University of Illinois at Chicago, Chicago, IL, USA |
Abstract
Background: Although the incidence of pulmonary embolism (PE) among trauma patients varies, it remains associated with substantial morbidity and mortality (PMID: 33224594). In this context, many PE are thought to result from de novo thrombosis within the pulmonary arteries, potentially driven by autonomic dysfunction and transient hypercoagulable state induced by trauma (PMID: 30836300, 19841360, 32929548). Sickle cell disease (SCD) has been associated with hypercoagulability related to intravascular hemolysis, oxidative stress and chronic inflammation. Consequently, SCD patients who experience trauma may have a synergistic risk for thrombosis. There is limited research examining this association Objectives: Primary objective of the study was to examine the risk of PE and its impact on inpatient mortality, length of hospital stay (LOS), total hospital charges (THC) among trauma related hospitalization in those with SCD. Secondary objective was to evaluate the effect of PE on inpatient clinical outcomes including severe sepsis, acute kidney injury (AKI), acute respiratory failure (ARF), mechanical ventilation use and ICU utilization. Methods: This retrospective cohort study used the National Inpatient Sample (NIS) dataset spanning 2008 to 2022. We identified adult ( ≥18 years) hospitalizations with a diagnosis of SCD and traumatic injury using ICD-CM codes. The study population was dichotomized based on PE diagnosis. Univariate, and multivariable logistic and linear regression models were performed to assess associations between PE and both primary and secondary outcomes. Results: A total of 18,610 trauma-related hospitalizations in those with SCD were identified over the 15-year study period. Of these, 187 (1%) were diagnosed with PE. Trauma was associated with a higher, though not statistically significant, risk of PE (adjusted odds ratio [AOR]: 1.24; P=0.2) in those with SCD. On adjusted analyses, PE was significantly associated with increased odds of inpatient mortality (10% vs. 1.9%; AOR: 6.25, P=0.002) compared to those without PE. The LOS was also significantly prolonged in those with PE (22 vs. 7 days; β: 15.1, P=0.005). THC was also increased ($303,799 vs. $ 77,214; β: $225,094, P<0.001 ) relative to those without PE. Secondary outcomes analysis demonstrated that PE was linked to markedly increased odds of severe sepsis (18.8% vs 1.9%; AOR: 12.08, P<0.001), AKI (24.1% vs 10.7%; AOR: 3.04, P:0.013), ARF (21.2% vs 5.7%; AOR:4.48, P<0.001). Additionally, those with PE had a higher need for mechanical ventilation (21.2% vs 5.2%; AOR:5.16, P<0.001) and ICU utilization (23.9% vs 5.4%; AOR: 5.83, P<0.001). Conclusion: PE was associated with significantly worse clinical outcomes among trauma-related hospitalizations in SCD. Although limited by a small sample size, the observed risk of PE in this study highlights an important area for further investigation. In SCD, the lungs are fairly hypoxic, promoting RBC sickling, increased blood viscosity, and hemolysis. We speculate that these factors create a positive feedback loop of pathophysiology, similar to that seen in acute chest syndrome, thereby contributing to an elevated risk of in situ pulmonary embolism in SCD patients following trauma (PMID: 36856299). Future research confirming or refuting this risk, characterizing predictive factors and exploring targeted, risk-reducing intervention are needed to improve outcomes.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.