Faculty Collaboration Database

Blunt pulmonary contusion: admission computed tomography scan predicts mechanical ventilation. J Trauma 2011 Dec;71(6):1543-7

Date

08/23/2011

Pubmed ID

21857256

DOI

10.1097/TA.0b013e31822c4a8b

Scopus ID

2-s2.0-84355163033 (requires institutional sign-in at Scopus site)   41 Citations

Abstract

BACKGROUND: Blunt pulmonary contusion (BPC) evolves over 12 to 24 hours, and the initial plain radiographs fail to reliably identify patients at risk of clinical deterioration. Admission computed tomography (CT) may offer accurate characterization of BPC and early prediction of the need for mechanical ventilation (MV).

METHODS: This was a combination of a 5-year retrospective study (January 2002 to April 2007) and a 6-month prospective study (September 2007 to February 2008) of adult blunt trauma (BT) patients with thoracic injuries and a chest CT upon hospital arrival. The primary outcome was MV due to thoracic trauma. To ensure that MV was required for BPC and not for associated injuries, all patients with significant extrathoracic injuries (Abbreviated Injury Scale score >2) were excluded. The extent of BPC was measured by two scoring systems.

RESULTS: Of 392 patients (67% males; age, 48 years ± 21 years; Abbreviated Injury Scale score chest, 3 ± 1; and Injury Severity Score [ISS], 13 ± 6), 243 (62%) had BPC. Twenty-five (6%) patients required MV and two (0.5%) died. The combination of Glasgow Coma Scale (GCS) score <14, BPC score >2, and >4 ribs fractured predicted MV in 100% of the cases, and the absence of all factors precluded MV in 100%. In the prospective period of 6 months, 55 patients had BPC and we confirmed our finding that the absence of the three factors precludes MV.

CONCLUSION: A simple score derived by the initial chest CT, in combination with GCS and the number of fractured ribs, can predict the need for MV early. In the presence of these predictors, patients should be admitted to a high level of monitoring.

Author List

de Moya MA, Manolakaki D, Chang Y, Amygdalos I, Gao F, Alam HB, Velmahos GC

Author

Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Accidents, Traffic
Adult
Aged
Cohort Studies
Contusions
Female
Glasgow Coma Scale
Hospital Mortality
Humans
Injury Severity Score
Lung Injury
Male
Middle Aged
Monitoring, Physiologic
Patient Admission
Predictive Value of Tests
Radiography, Thoracic
Respiration, Artificial
Retrospective Studies
Risk Assessment
Survival Rate
Thoracic Injuries
Tomography, X-Ray Computed
Trauma Centers
Wounds, Nonpenetrating