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Blunt pulmonary contusion: admission computed tomography scan predicts mechanical ventilation
Marc A de Moya1, Dimitra Manolakaki, Yuchiao Chang
1Division of Trauma Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. mdemoya@partners.org
The Journal of Trauma
|August 23, 2011
Summary
Blunt pulmonary contusion (BPC) requires early prediction of mechanical ventilation (MV) needs. Initial chest CT scans, Glasgow Coma Scale, and rib fractures can accurately predict which patients will need MV.
Area of Science:
- Trauma surgery
- Thoracic imaging
- Critical care medicine
Background:
- Blunt pulmonary contusion (BPC) evolution is unpredictable with initial radiographs.
- Early identification of patients at risk for clinical deterioration is crucial.
- Computed tomography (CT) may aid in characterizing BPC and predicting mechanical ventilation (MV) needs.
Purpose of the Study:
- To evaluate the utility of initial chest CT in predicting MV in blunt trauma patients.
- To develop a predictive score for MV requirement in BPC patients.
- To identify patients needing a higher level of monitoring.
Main Methods:
- Retrospective and prospective study of adult blunt trauma patients with thoracic injuries.
- Chest CT performed upon hospital arrival.
- Exclusion of patients with significant extrathoracic injuries to isolate BPC impact on MV.
Main Results:
- 62% of patients had BPC; 6% required MV.
- A combination of Glasgow Coma Scale (GCS) score <14, BPC score >2, and >4 fractured ribs predicted 100% of MV cases.
- Absence of these factors precluded the need for MV.
Conclusions:
- A simple score using initial chest CT, GCS, and rib fractures can predict early MV needs.
- Patients with these predictors require admission to a high level of monitoring.
- This scoring system aids in timely clinical decision-making for trauma patients.
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