R. S. Jawa1, J. E. McCormack1, E. C. Huang1, M. J. Shapiro1, J. A. Vosswinkel1 1Stony Brook University Medical Center,Trauma,Stony Brook, NY, USA
Introduction: There is limited information regarding hospitalization and discharge characteristics of blunt trauma patients with pulmonary contusions, especially those with isolated pulmonary contusions (IP). We evaluated the prevalence and outcomes following pulmonary contusion in a suburban county of 1.5 million people.
Methods: A county-wide trauma registry for all admitted adult blunt trauma patients from 1999 to 2008 was examined. Emergency Room deaths were excluded. Three groups were analyzed: isolated pulmonary contusion (IP), pulmonary contusion + other chest injury (CH), and pulmonary contusion + chest injury + other body region injury (OT).
Results: There were 14,286 admissions. The major mechanisms of injury in the three groups were MVC/MCC (58.8% OT, 45.6% CH, and 72.1%IP*,^) followed by falls (42.6% OT, 31.4% CH, and 12.9% IP*,^). Pulmonary contusions were associated with rib fractures in 55.4% of OT#, 82.2% of CH, and 0% of IP*,^ patients. The median hospital length of stay was longer in OT patients (9 [IQR 5-19] days), as compared to CH (6 [IQR 4-10)) and IP patients (4 [IQR 2-6]) *,^. Mechanical ventilation was required more often in the OT (36.1%#) than CH (8.1%) or IP (5.9%^) groups. The most commonly severely injured regions (AIS≥3) in the OT group were chest (100%), head/neck (33.6%), and extremity (26.6%). Hemothorax/pneumothorax or a combination thereof was present in 45.6%OT#, 54.1%CH and 0%IP*,^ patients. Rib fractures were present in 55.4% OT#, 82.2% CH, and 0% IP patients*,^.Tracheostomy was required in 10.1% OT#, 2.2%CH, and 0%IP^ patients. A chest tube was placed in 28.1% OT#, 23.0% CH, and 2.0% IP*,^ patients; 1 IP likely had chest tube placement for presumed blood/air. The most common major surgical procedure in the OT group was orthopedic at 32.0%. Finally, 57.7% OT#, 84.4% CH, and 86.3% IP^ patients were discharged to home.
Conclusion: Pulmonary contusions are not infrequent following blunt trauma, with a 13.0% incidence. They rarely (2.7%) occur in isolation; most frequently they are associated with rib fractures. However, 45.4% of blunt multi-system trauma patients will have pulmonary contusions in the absence of rib fractures, as compared to only 18.8% of patients with isolated chest injuries. Further, the presence of a pulmonary contusion warrants an aggressive search for additional injuries; 98.6% of multi-trauma patients had major non-thoracic injuries. The additional injuries will often require major surgical procedures, with orthopedic surgery being the most common. Pulmonary contusions in association with other injuries are associated with substantial mortality as well as morbidity, as measured by the need for ICU care, mechanical ventilation, and low discharge to home rate.
