Clinical Significance and Prognostic Implications of Quantifying Pulmonary Contusion Volume in Patients with Blunt Chest Trauma

Abstract

BackgroundPulmonary contusion (PC) is the most frequent blunt chest injury which could be used to identify patients at high-risk of clinical deterioration. We aimed to investigate the clinical correlation between PC volume and outcome in patients with blunt chest trauma (BCT).Material/MethodsBCT patients with PC were identified retrospectively from the prospectively collected trauma registry database over a 2-year period. Contusion volume was measured and expressed as percentage of total lung (CTCV) volume using three-dimensional reconstruction of thoracic CT images on admission. Data included patients’ demographics, mechanism of injury (MOI) and injury severity, associated injuries, CTCV, mechanical ventilation, complications, and mortality.ResultsA total of 226 BCT patients were identified to have PC with a mean age of 35.2 years. Motor vehicle crash (54.4%) and falls (16.4%) were the most frequent MOIs. Bilateral PC (61.5%) was more prevalent than right-sided (19.5%) and left-sided PC (19%). CTCV had a significant positive correlation with ISS; whereas, age and PaO2/FiO2 ratio showed a negative correlation (p<0.05 for all). The median CTCV was significantly higher in patients who developed in-hospital complications (p=0.02). A CTCV >20% was associated with increasedrisk of acute respiratory distress syndrome (ARDS), blood transfusion and prolonged mechanical ventilation. However, multiple linear regression analysis showed that CTCV alone was not an independent predictor of in-hospital outcomes. Presence of chest infection, CTCV, and Injury Severity Scores were predictors of ARDS.ConclusionsQuantifying pulmonary contusion volume could allow identification of patients at high-risk of ARDS. CTCV has a significant correlation with injury severity in patients with BCT. Further prospective studies are needed to address the validity of CTCV in the patients care.

Blunt Chest Trauma; Differences Between Children and Adult in Menoufia University Emergency Hospital

“…Lung contusion was found in 71.4% of children with chest injury and in 66.7% of adult. This is in accordance with Mahmood et al (7) who stated that pulmonary contusion is the most frequent chest injury (25-80%) and Skinner et al (4) stated that children suffer more lung contusions.…”

Pulmonary contusions in patients with rib fractures: The need to better classify a common injury

“…Several institutional studies have shown that contused lung volumes positively correlate with degree of impaired oxygenation, risk of developing ARDS, and prolonged intubation. 7,8,14 Validating these studies may inform clinical decision-making, such as identifying a cutoff of contused lung volume that significantly increases risk of respiratory failure and perhaps pre-emptively admitting these patients to the intensive care unit.…”

“…For example, Mahmood et al reported that 20% contused lung volumes were associated with increased risk of acute respiratory distress syndrome and prolonged mechanical ventilation among patients who suffered blunt chest trauma. 7 Validating clinically meaningful contused lung volume cutoffs requires further individual CT scan evaluations at the institutional level. Future studies exploring the association between contused lung volumes and outcomes should also note that pulmonary contusions are not static injuries; evolution of traumatic pulmonary contusions requires better characterization.…”

“…Early studies suggest contused lung volumes are correlated with worse pulmonary complication rates, yet dichotomous classification limits exploring this relationship at a large scale. 7,8 We evaluated the nationwide impact of unilateral and bilateral pulmonary contusions eproxies for increasingly contused lung volumese on patients who suffer rib fractures. We hypothesized that among patients with rib fractures, there is a stepwise increase in risk of pulmonary complications and mortality among patients without, with unilateral, and with bilateral pulmonary contusions.…”

Assessment of thoracic volume changes after the collapse of lateral rib fractures based on chest computed tomography data: computer simulation and a multiple variable linear regression analysis

“…Severe thoracic deformities can affect cardiopulmonary function, reduce chest and lung compliance, and lead to impaired respiratory function. These mechanical and inflammatory sequelae often complicate the care of patients with CBT and increase the risk of pneumonia, acute respiratory failure, and even acute respiratory distress syndrome (ARDS) [11]. Patients with chest trauma and rib fractures often show respiratory dysfunction, especially when a flail chest is present.…”