A. Bader1, M. Morris1, J. A. Vosswinkel1, J. E. McCormack1, E. C. Huang1, R. S. Jawa1 1Stony Brook University Medical Center,Stony Brook, NY, USA
Introduction: In patients with blunt chest trauma, pulmonary contusions are variably identified. However, there is limited research on the outcomes of elderly patients with pulmonary contusion.
Methods: We retrospectively reviewed the trauma registry for all admissions aged ≥65 years, admitted following blunt trauma with a thoracic injury. Emergency Room deaths were excluded. The medical records of patients with pulmonary contusions were subsequently reviewed for additional details.
Results: There were 960 patients age ≥65 years admitted with thoracic trauma, of which 180 had pulmonary contusions (PC) and 780 had no pulmonary contusion (NO). The major mechanisms of injury were MVC/MCC (52.22% PC, 35.64% NO, p<0.001) followed by falls (38.89% PC, 58.72% NO, p<0.001). Rib fractures were present in 80% of PC and 73.5% of NO patients, p=0.09. Hemothorax/pneumothorax was more prevalent in those with pulmonary contusions (44.44% PC vs 19.23% NO, p<0.001). While 98.3% of PC patients had chest AIS≥3, 41.9% of NO patients had chest AIS≥3, p<0.001. Hospitalization outcomes are presented in the table. Chart review of PC patients noted that pulmonary contusion was identified in only 34/180 patients on initial CXR. An additional 22 patients were noted to have pulmonary contusion on a subsequent CXR. A CT thorax was performed in 174 patients within 24 hours of admission. This CT scan identified the pulmonary contusion. Further, rib fractures were identified in 80% of PC patients.
Conclusion: Pulmonary contusions in the elderly blunt trauma population were infrequently identified on CXR. They are associated with severe chest injury. Their presence is associated with substantial morbidity and mortality. The data suggest the need for increased vigilance for pulmonary contusion such as early chest CT scan performance in this population. Further study is warranted.
