G. Vasileiou1, J. Parks1, D. D. Yeh1, R. Rattan1, T. Zakrison1, N. Namias1, G. D. Pust1 1University Of Miami,Surgery,Miami, FL, USA
Introduction: Fat embolism (FE) is a rare complication after trauma that may have devastating consequences. Our objective was to describe the incidence of and clinical outcomes after FE.
Methods: The 2008- 2014 National Trauma Data Bank (NTDB) were queried for FE, using ICD9 958.1. Descriptive analysis of demographics, injury, and hospitalization characteristics was carried out. Multivariate logistic regression analysis for mortality was performed controlling for age, gender, ISS score, and intensive care unit (ICU) admission.
Results: Out of 4,495,935 patients, we identified 418 (0.01%) diagnosed with FE. Median age was 32 [21-62], and 275 (66%) were male. Of those, 393 (94%) had blunt mechanism, and 407 (97%) had fractures; femur fractures were the most common 286 (68%); followed by multiple bone fractures 225 (54%); other (ribs, vertebra, radius, ulna, etc) bone fractures 200 (48%); tibia and/or fibula 130 (31%); pelvis 78 (19%); and humerus 31 (7%) fractures. Median time to OR was 15 [6 – 34] hours.Internal fixation was performed in 248 (59%), followed by procedures without internal fixation in 47 (12%), and removal of implants in 35 (9%) patients. ICU admission was required in 291 (70%) patients, and 152 (36%) needed mechanical ventilation for 6 [2-11] days. Median hospital length of stay (LOS) and ICU LOS were 10 [6-16] and 5 [2-12] days, respectively. Median Injury Severity Score (ISS) was 10 [9-18], yet in-hospital mortality was 13% (n=54). There were 169 (40%) patients that were discharged home with or without additional services while 184 (44%) were transferred to other facilities. Multivariate logistic regression analysis showed that mortality was associated with ventilation (OR: 4.05; 95% CI [2.01-8.13]; p<0.001), age (OR: 1.02; 95% CI [1.01-1.03]; p=0.006), and ISS (OR: 1.04; 95% CI [1.01-1.07]; p=0.018), (Table 1).
Conclusion: Fat embolism is an extremely rare complication that occurs almost exclusively in trauma patients with fractures. FE is associated with higher-than-expected mortality based on ISS and most patients require ICU admission and usually with concomitant mechanical ventilation. Formal diagnostic criteria and severity grading is the next step required for improving diagnostic accuracy and treatment of this entity.
