Abstract
Background
Orthopaedic surgeons are increasingly pressured to consider thromboprophylaxis for patients when little evidence exists. The aim of this study was to determine the incidence of fatal pulmonary embolism following office attendance in our outpatient fracture clinic.
Methods
Between October 2004 and September 2006 details of all new patients referred to our orthopaedic fracture clinic were prospectively entered into an audit database. Patients did not receive any form of thromboprophylaxis. Data was cross referenced with a national mortality database to identify all patients who subsequently died within 90 days of attendance in fracture clinic.
Results
11,502 new patient fracture clinic appointments occurred during the study period. 5604 patients had lower limb injuries. Twenty three patients died within 90 days of being seen. The mean age of these patients was 75 years (range 52–100). Two of the 23 patients attended fracture clinic with lower limb injuries. Review of the medical records showed no evidence of pulmonary embolism. Assuming a worst case scenario that both died of fatal pulmonary embolism the incidence of fatal pulmonary embolism following attendance in fracture clinic with a lower limb injury is no higher than 0.036% (95% CI 0.09%–0.33%).
Conclusion
The incidence of fatal PE following outpatient management of lower limb fractures is very low. This incidence data will inform decisions on the risk-benefit analyisis of thromboprophylaxis in this group of patients.
