PURPOSE: To determine the incidence of pulmonary embolism (PE) in wounded soldiers compared to the general population with clinical concern for PE with a goal to improve specificity and sensitivity of the current MDCT techniques and to establish guidelines to manage high risk population with specific protocols.
METHODS: Four hundred seventy five CT PE/DVT exams performed at our institution from June of 2009 through March of 2010 were reviewed retrospectively. All studies were done on a 64 slice MDCT with smart-prep technique and a minimum main pulmonary artery density of 120 Hounsfield units. Patients with combat related injuries (n=57) were separated from the general population with clinical concern for a PE (n=418). The rates of PE and non-diagnostic exam for each group were identified.
RESULTS: Preliminary results demonstrate an increased rate of PE in wounded soldiers (26%) compared with the general population (18%). There was also a threefold increased rate of non-diagnostic exams, 35% compared to 11% respectively.
CONCLUSION: Wounded soldiers have a higher incidence of PE than in our general population. In addition, there is an increased rate of non-diagnostic exams due to technical failures in this poly-trauma population. We propose to establish guidelines for specific protocols in high risk poly-trauma population including appropriate screening for deep venous thrombosis by sonogram, indicated placement of retrievable caval filters, and modified MDCT PE/DVT techniques (including gating, tailored pitch, tailored smart-prep technique, high quality venous access and 6 ml/sec injection rate).
CLINICAL IMPLICATIONS: There is a significant increased incidence of PE and increased rate of non-diagnostic exams in poly-trauma patients. The results may have universal application with this population that may require modification of techniques to improve sensitivity and specificity of the CT PE/DVT exams and clinical management of this population.
DISCLOSURE: Binh Nguyen, No Financial Disclosure Information; No Product/Research Disclosure Information