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

Abstract

Background: Pulmonary contusions are common injuries. Computed tomography reveals vast contused lung volume spectrum, yet pulmonary contusions are defined dichotomously (unilateral vs bilateral). We assessed whether there is stepwise increased risk of pulmonary complications among patients without, with unilateral, and with bilateral pulmonary contusion. Methods: We identified adults admitted with rib fractures using the largest US inpatient database. After propensity-score-matching patients without vs with unilateral vs bilateral pulmonary contusions and adjusting for residual confounders, we compared risk for pneumonia, ventilator-associated pneumonia (VAP), respiratory failure, intubation, and mortality. Results: Among 148,140 encounters of adults with multiple rib fractures, 19% had concomitant pulmonary contusions. Matched patients with pulmonary contusions had increased risk of pneumonia 19% [95%CI:16e33%], respiratory failure 40% [95%CI: 31e50%], and intubation 46% [95%CI: 33e61%]. Delineation showed bilateral contusions, not unilateral contusions, attributed to increased risk of complications. Conclusions: There is likely a correlation between contused lung volume and risk of pulmonary complications; dichotomously classifying pulmonary contusions is insufficient. Better understanding this correlation requires establishing the clinically significant contusion volume and a correspondingly refined classification system.

ICU Length of Stay and Factors Associated with Longer Stay of Major Trauma Patients with Multiple Rib Fractures: A Retrospective Observational Study

“…There has been some debate as to whether lung contusions increase ICU LOS. Multiple studies [ 7 , 35 , 36 ] have reported that lung contusions were associated with worse outcomes and prolonged ICU and hospital LOS. Fokin et al and Dhar et al did not find differences in ICU LOS with or without lung contusions in major trauma patients [ 37 , 38 ].…”

Rib fixation in patients with severe rib fractures and pulmonary contusions: Is it safe?

“…12,13 Because pulmonary contusions can vary in size and severity, dichotomously classifying the presence or absence of pulmonary contusions is insufficient to appreciate the extent of the injury. 14 Furthermore, the severity of the pulmonary contusions detected on CT scan can change radiographically over time, especially in the first hours after injury. 15,16 Surgical stabilization of rib fractures (SSRFs) is increasingly used in the management of patients with severe rib fractures.…”

“…Currently, chest computed tomography (CT) is the recommended diagnostic modality, since it is highly sensitive in diagnosing pulmonary contusions 12,13 . Because pulmonary contusions can vary in size and severity, dichotomously classifying the presence or absence of pulmonary contusions is insufficient to appreciate the extent of the injury 14 . Furthermore, the severity of the pulmonary contusions detected on CT scan can change radiographically over time, especially in the first hours after injury 15,16 …”

Scalable deep learning algorithm to compute percent pulmonary contusion among patients with rib fractures

“…P ulmonary contusions are present in nearly 20% of adults hospitalized with multiple rib fractures. 1 Inflammatory sequelae of pulmonary contusions can reduce thoracic compliance 2,3 and potentiate acute respiratory distress syndrome or other respiratory morbidities. [4][5][6] Pulmonary contusion is a pathology existing along a spectrum of severity, yet many databases, ontologies, and studies binarily classify contusions as present or absent.…”