The prevalence of pulmonary embolism in chronically paralyzed subjects: a review of available evidence

Study design: Qualitative systematic review. Objectives: To examine the validity of the prevailing notion that pulmonary embolism (PE) is rare in the chronic spinal cord injury (SCI) population. Setting: USA. Methods: Review surveys of adult SCI subjects >2 months after injury in which PE has been looked for and its prevalence estimated. Results: A total of 16 surveys of chronic SCI subjects published between 1956 and 2009 offered data on PE prevalence. Two autopsy surveys, 178 subjects paralyzed >2 months, revealed no PE. Eleven surveys of the cause of death, 3193 subjects paralyzed 1–25 years, revealed PE in 2.1%. Two surveys of survivors of SCI, 5761 subjects paralyzed 1–25 years, revealed PE in 0.4%. Our survey of 112 subjects paralyzed 1–50 years before death, revealed PE in 21 (18.7%), based on autopsy, imaging, clinical and electrocardiographic evidence. In 7 (33%) of the 21 subjects with PE, pulmonary hypertension by transthoracic echocardiography was detected, indicating recurrent and/or unresolved PE. Conclusion: PE is not infrequent in the chronic SCI subject; but its presentation may be subclinical; and its apparent recurrence may lead to pulmonary hypertension.