Incidence of pulmonary fat embolism at autopsy: an undiagnosed epidemic

To determine the incidence, time course, and severity of pulmonary fat embolism (PFE) and cerebral fat embolism (CFE) in trauma and nontrauma patients at the time of autopsy. Prospectively, consecutive patients presenting for autopsy were evaluated for evidence pulmonary and brain fat embolism. The...

Full description

Saved in:
Bibliographic Details
Published inThe journal of trauma Vol. 71; no. 2; p. 312
Main Authors Eriksson, Evert Austin, Pellegrini, Daniela C, Vanderkolk, Wayne E, Minshall, Christian T, Fakhry, Samir M, Cohle, Stephen D
Format Journal Article
LanguageEnglish
Published United States 01.08.2011
Subjects
Online AccessGet more information
ISSN1529-8809
DOI10.1097/TA.0b013e3182208280

Cover

Abstract To determine the incidence, time course, and severity of pulmonary fat embolism (PFE) and cerebral fat embolism (CFE) in trauma and nontrauma patients at the time of autopsy. Prospectively, consecutive patients presenting for autopsy were evaluated for evidence pulmonary and brain fat embolism. The lung sections were obtained from the upper and lower lobe of the patients' lungs on the right and left and brain tissue. This tissue was prepared with osmium tetroxide for histologic evaluation. The number of fat droplets per high power field was counted for all sections. The autopsy reports and medical records were used to determine cause of death, time to death, injuries, if cardiopulmonary resuscitation (CPR) was attempted, sex, height, weight, and age. Fifty decedents were evaluated for PFE and CFE. The average age was 45.8 years ± 17.4 years, average body mass index was 30.1 kg/cm² ± 7.0 kg/cm², and 68% of the patients were men. The cause of death was determined to be trauma in 68% (34/50) of decedents, with 88% (30/34) blunt and 12% (4/34) penetrating. CPR was performed on 30% (15/50), and PFE was present in 76% (38/50) of all patients. Subjects with PFE had no difference with respect to sex, trauma, mechanism of injury, CPR, external contusions, fractures, head, spine, chest, abdominal, pelvic, and extremity injuries. However, subjects without PFE had significantly increased weight (109 ± 29 kg vs. 86 ± 18 kg; p = 0.023) but no difference in height or body mass index. PFE was present in 82% (28/34) of trauma patents and 63% (10/16) nontrauma patients. Eighty-eight percent of nontrauma patients and 86% of trauma patients who received CPR had PFE. Trauma patients with PFE showed no significant difference in any group. Eighty-eight percent of trauma patients died within 1 hour of injury, and 80% (24/30) of them had PFE at the time of autopsy. CFE was present only in one patient with a severe head and cervical spine injury. PFE is common in trauma patients. CPR is associated with a high incidence of PFE regardless of cause of death. PFE occurs acutely within the "golden hour" and should be considered in traumatically injured patients. Further studies are needed to evaluate the pathogenesis of PFE.
AbstractList To determine the incidence, time course, and severity of pulmonary fat embolism (PFE) and cerebral fat embolism (CFE) in trauma and nontrauma patients at the time of autopsy. Prospectively, consecutive patients presenting for autopsy were evaluated for evidence pulmonary and brain fat embolism. The lung sections were obtained from the upper and lower lobe of the patients' lungs on the right and left and brain tissue. This tissue was prepared with osmium tetroxide for histologic evaluation. The number of fat droplets per high power field was counted for all sections. The autopsy reports and medical records were used to determine cause of death, time to death, injuries, if cardiopulmonary resuscitation (CPR) was attempted, sex, height, weight, and age. Fifty decedents were evaluated for PFE and CFE. The average age was 45.8 years ± 17.4 years, average body mass index was 30.1 kg/cm² ± 7.0 kg/cm², and 68% of the patients were men. The cause of death was determined to be trauma in 68% (34/50) of decedents, with 88% (30/34) blunt and 12% (4/34) penetrating. CPR was performed on 30% (15/50), and PFE was present in 76% (38/50) of all patients. Subjects with PFE had no difference with respect to sex, trauma, mechanism of injury, CPR, external contusions, fractures, head, spine, chest, abdominal, pelvic, and extremity injuries. However, subjects without PFE had significantly increased weight (109 ± 29 kg vs. 86 ± 18 kg; p = 0.023) but no difference in height or body mass index. PFE was present in 82% (28/34) of trauma patents and 63% (10/16) nontrauma patients. Eighty-eight percent of nontrauma patients and 86% of trauma patients who received CPR had PFE. Trauma patients with PFE showed no significant difference in any group. Eighty-eight percent of trauma patients died within 1 hour of injury, and 80% (24/30) of them had PFE at the time of autopsy. CFE was present only in one patient with a severe head and cervical spine injury. PFE is common in trauma patients. CPR is associated with a high incidence of PFE regardless of cause of death. PFE occurs acutely within the "golden hour" and should be considered in traumatically injured patients. Further studies are needed to evaluate the pathogenesis of PFE.
Author Eriksson, Evert Austin
Fakhry, Samir M
Cohle, Stephen D
Minshall, Christian T
Pellegrini, Daniela C
Vanderkolk, Wayne E
Author_xml – sequence: 1
  givenname: Evert Austin
  surname: Eriksson
  fullname: Eriksson, Evert Austin
  email: evert.eriksson@gmail.com
  organization: Department of Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA. evert.eriksson@gmail.com
– sequence: 2
  givenname: Daniela C
  surname: Pellegrini
  fullname: Pellegrini, Daniela C
– sequence: 3
  givenname: Wayne E
  surname: Vanderkolk
  fullname: Vanderkolk, Wayne E
– sequence: 4
  givenname: Christian T
  surname: Minshall
  fullname: Minshall, Christian T
– sequence: 5
  givenname: Samir M
  surname: Fakhry
  fullname: Fakhry, Samir M
– sequence: 6
  givenname: Stephen D
  surname: Cohle
  fullname: Cohle, Stephen D
BackLink https://www.ncbi.nlm.nih.gov/pubmed/21825932$$D View this record in MEDLINE/PubMed
BookMark eNo1T0tLw0AYXESxD_0FguwfSP32mV1vpWgtFLzUc9nHtxJJdkPTHPrvDWgvM3OYGWYW5DaXjIQ8MVgxsPXLYb0CD0ygYIZzMNzADZkzxW1lDNgZWQzDDwBIKcw9mfHJpazgc7Ld5dBEzAFpSbQf265kd7rQ5M4UO1_aZujopN14Lv1weaUu0zHHxn3nMmCk2E_prgkP5C65dsDHf16Sr_e3w-aj2n9ud5v1vgqitnpCpiLTliHKYIMOtkYVInIvnIqokrcoas29s0y6pEFpj1ZLyRlPADVfkue_3n70HcZjf2q6ae_x-oj_Asd1TpE
CitedBy_id crossref_primary_10_1007_s12024_018_0044_1
crossref_primary_10_1016_j_jcrc_2014_09_008
crossref_primary_10_1097_TA_0000000000001278
crossref_primary_10_1155_2018_7813175
crossref_primary_10_1080_01902148_2018_1552339
crossref_primary_10_1111_1556_4029_15083
crossref_primary_10_1177_175114371301400407
crossref_primary_10_1002_sono_12397
crossref_primary_10_15406_mojcr_2015_03_00071
crossref_primary_10_1007_s12630_014_0137_6
crossref_primary_10_1136_jclinpath_2013_202056
crossref_primary_10_1177_1460408615589430
crossref_primary_10_1016_j_injury_2013_11_018
crossref_primary_10_1016_j_radcr_2017_04_004
crossref_primary_10_1111_1556_4029_15459
crossref_primary_10_3109_10903127_2014_980475
crossref_primary_10_1177_0963689718814766
crossref_primary_10_52586_5067
crossref_primary_10_1097_TA_0b013e31825a76cb
crossref_primary_10_4236_ojanes_2013_34052
crossref_primary_10_3892_etm_2013_1143
crossref_primary_10_5847_wjem_j_1920_8642_2023_053
crossref_primary_10_1161_CIRCULATIONAHA_114_010835
crossref_primary_10_1016_j_medleg_2020_08_002
crossref_primary_10_1016_j_arth_2014_10_006
crossref_primary_10_1007_s11739_014_1094_3
crossref_primary_10_1007_s00428_024_04000_6
crossref_primary_10_1016_j_radcr_2024_10_126
crossref_primary_10_1111_1556_4029_15465
crossref_primary_10_3109_03009734_2013_818600
crossref_primary_10_1007_s00068_024_02516_9
crossref_primary_10_7759_cureus_22192
ContentType Journal Article
DBID CGR
CUY
CVF
ECM
EIF
NPM
DOI 10.1097/TA.0b013e3182208280
DatabaseName Medline
MEDLINE
MEDLINE (Ovid)
MEDLINE
MEDLINE
PubMed
DatabaseTitle MEDLINE
Medline Complete
MEDLINE with Full Text
PubMed
MEDLINE (Ovid)
DatabaseTitleList MEDLINE
Database_xml – sequence: 1
  dbid: NPM
  name: PubMed
  url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
– sequence: 2
  dbid: EIF
  name: MEDLINE
  url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search
  sourceTypes: Index Database
DeliveryMethod no_fulltext_linktorsrc
EISSN 1529-8809
ExternalDocumentID 21825932
Genre Research Support, Non-U.S. Gov't
Journal Article
GroupedDBID .3C
.55
.GJ
.XZ
.Z2
01R
0R~
1CY
1J1
1KJ
354
40H
4Q1
4Q2
4Q3
53G
5RE
5VS
6PF
71W
77Y
7O~
9V3
AAAAV
AAAXR
AAGIX
AAIQE
AAJCS
AAMOA
AAMTA
AAQQT
AARTV
AAUEB
AAWTL
AAXQO
ABBUW
ABDIG
ABXVJ
ABZAD
ACCJW
ACDDN
ACDOF
ACEWG
ACIJW
ACILI
ACOAL
ACWDW
ACWRI
ACXNZ
ACZKN
ADFPA
ADGGA
ADHPY
ADNKB
AE3
AE6
AEETU
AFDTB
AFEXH
AFNMH
AFUWQ
AHOMT
AHQNM
AHRYX
AHVBC
AI.
AIJEX
AINUH
AJCLO
AJIOK
AJNWD
AJNYG
AJZMW
ALKUP
ALMA_UNASSIGNED_HOLDINGS
AMJPA
AMNEI
BOYCO
BQLVK
BS7
BYPQX
C45
CGR
CUY
CVF
DIWNM
DUNZO
E.X
EBS
ECM
EIF
EJD
EX3
F2K
F2L
F2M
F2N
F5P
FL-
FW0
H0~
HZ~
IKREB
IN~
J5H
JF9
JG8
JK3
JK8
K8S
KD2
KMI
L7B
M18
N9A
NPM
N~7
N~B
N~M
O9-
OAG
OAH
OB4
OBH
OCUKA
ODA
ODMTH
OHH
OHYEH
OL1
OLB
OLG
OLH
OLU
OLV
OLY
OLZ
ONV
OPUJH
ORVUJ
OUVQU
OVD
OVDNE
OVIDH
OVLEI
OVOZU
OWBYB
OWU
OWV
OWW
OWX
OWY
OWZ
OXXIT
P-K
PONUX
R58
S4R
S4S
T8P
TEORI
V2I
VH1
VVN
W3M
WH7
WOQ
WOW
X3V
X3W
X7M
XXN
XYM
ZFV
ZGI
ZXP
ZY1
ZZMQN
ID FETCH-LOGICAL-c3796-c315d1691ee4c9c6c97e5cde2b3a5de5fb9e3762ba914af6056be9644212f0072
IngestDate Thu Apr 03 06:56:14 EDT 2025
IsPeerReviewed false
IsScholarly false
Issue 2
Language English
LinkModel OpenURL
MergedId FETCHMERGED-LOGICAL-c3796-c315d1691ee4c9c6c97e5cde2b3a5de5fb9e3762ba914af6056be9644212f0072
PMID 21825932
ParticipantIDs pubmed_primary_21825932
PublicationCentury 2000
PublicationDate 2011-August
PublicationDateYYYYMMDD 2011-08-01
PublicationDate_xml – month: 08
  year: 2011
  text: 2011-August
PublicationDecade 2010
PublicationPlace United States
PublicationPlace_xml – name: United States
PublicationTitle The journal of trauma
PublicationTitleAlternate J Trauma
PublicationYear 2011
SSID ssj0004438
Score 1.6800209
Snippet To determine the incidence, time course, and severity of pulmonary fat embolism (PFE) and cerebral fat embolism (CFE) in trauma and nontrauma patients at the...
SourceID pubmed
SourceType Index Database
StartPage 312
SubjectTerms Accidents, Traffic - statistics & numerical data
Adult
Aged
Cardiopulmonary Resuscitation
Embolism, Fat - epidemiology
Embolism, Fat - pathology
Female
Fractures, Bone - epidemiology
Humans
Incidence
Intracranial Embolism - epidemiology
Intracranial Embolism - pathology
Male
Middle Aged
Pulmonary Embolism - epidemiology
Pulmonary Embolism - pathology
Wounds and Injuries - epidemiology
Young Adult
Title Incidence of pulmonary fat embolism at autopsy: an undiagnosed epidemic
URI https://www.ncbi.nlm.nih.gov/pubmed/21825932
Volume 71
hasFullText
inHoldings 1
isFullTextHit
isPrint
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3JTsMwELUKXLggEPsmH7ihQJrEac0NIRYhwakFbpXtjKWqJalocoA_4K8Z20kTFRDLxYriKEk9zy_jqecNIUdMMQZ-IjyufO3h91rhnEMsawbAtRSdWJuF4t19fNOPbp_YU6v13ti1VOTyRL19mVfyH6viObSryZL9g2VnN8UTeIz2xRYtjO2vbIyT29UEtfuWizE-2GyC07joh2eZjW0BjPxYFHk2mVppJ5zNRZq47XXoaoKrD6uaLqoBTkNPIn8RRc3dSJujaZmkdWlKOdtgyTCtGdbEIcy_QnX-uqgjsQ82l2aUjS0HP4pXdHFnqRB3w3RqSrvUmgeGfHrNuIQLtJZxCSi5NOAe0gNvkq2rt1KCKmgwZ-h2U39idKcU3DuvI7ZBYGT3_ObVOICTZ2tkI0jPeBj83Dsns111LZAFpFxTQdWEfaoE2yjsVpJVvHP6xdtYUWl3h7kFinVUeqtkpVxh0HMHlzXSgnSdXM-gQjNNZ1ChCBVaQYXicQmVMypS2gAKrYCyQfpXl72LG6-soeGpsMNjbNssMYJIAJHiKla8A0wlEMhQsASYlhzwGxNIwduR0Li4jSVwdJLRpdFGVn6TLKZZCtuEdrXwo6SLcz6RkYSAK6PNjQMQCu4LIXbIlvvdg4kTShlUI7L7bc8eWa6xs0-WNM5MOEA3L5eH1gQfmNFT2g
linkProvider National Library of Medicine
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Incidence+of+pulmonary+fat+embolism+at+autopsy%3A+an+undiagnosed+epidemic&rft.jtitle=The+journal+of+trauma&rft.au=Eriksson%2C+Evert+Austin&rft.au=Pellegrini%2C+Daniela+C&rft.au=Vanderkolk%2C+Wayne+E&rft.au=Minshall%2C+Christian+T&rft.date=2011-08-01&rft.eissn=1529-8809&rft.volume=71&rft.issue=2&rft.spage=312&rft_id=info:doi/10.1097%2FTA.0b013e3182208280&rft_id=info%3Apmid%2F21825932&rft_id=info%3Apmid%2F21825932&rft.externalDocID=21825932