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Outcome of lung trauma
M A Rashid1, T Wikström, P Ortenwall
1Department of Surgery, Sahlgrenska University, Hospital/Ostra, Gothenburg University, Sweden.
The European Journal of Surgery = Acta Chirurgica
|February 25, 2000
Summary
Penetrating lung injuries can be successfully managed with prompt surgical intervention, including emergency room thoracotomy. Pulmonary contusion in blunt trauma is generally benign, not increasing mortality, and may reduce unnecessary imaging.
Area of Science:
- Trauma Surgery
- Thoracic Surgery
- Emergency Medicine
Background:
- Pulmonary injuries result from both penetrating and blunt trauma.
- Management strategies for critical pulmonary hemorrhages require evaluation.
- The role of pulmonary contusion in blunt chest trauma morbidity needs clarification.
Purpose of the Study:
- To assess the management of critical pulmonary hemorrhages in penetrating injuries.
- To report experience with blunt lung trauma.
- To evaluate the impact of pulmonary contusion on patient outcomes.
Main Methods:
- Retrospective study of 81 patients with pulmonary injuries (6 penetrating, 75 blunt) from January 1988 to December 1997.
- Correlation of lung injury grade (American Association for the Surgery of Trauma-Abbreviated Injury Scale) with mortality.
- Analysis of patient outcomes based on injury type and presence of extrathoracic lesions.
Main Results:
- All patients with penetrating injuries survived with aggressive management and urgent surgery. Four patients required emergency interventions (thoracotomy, thoracoabdominal exploration).
- Pulmonary contusion was rarely isolated; patients with extrathoracic lesions had significantly more injuries (6 vs. 3 per patient) and higher mortality (19% vs. 0%).
- Injury Severity Score (ISS) was significantly higher in patients with extrathoracic lesions and those who died, indicating the severity of associated injuries.
Conclusions:
- Aggressive management and urgent surgical intervention, including emergency room thoracotomy, lead to excellent outcomes for penetrating lung injuries.
- Pulmonary contusion in blunt chest trauma is a relatively benign finding and does not significantly contribute to morbidity or mortality.
- These findings suggest a re-evaluation of the clinical significance of pulmonary contusion, potentially reducing unnecessary imaging in trauma patients.