The Association Between Pulmonary Contusion Severity and Respiratory Failure

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Pulmonary Medicine

Background:

• Pulmonary contusions (PCs) are common in thoracic trauma, but their impact on patient outcomes is debated.
• Previous studies often lack stratification by contusion severity, potentially obscuring clinical associations.
• This study investigates the association between pulmonary contusion severity and patient outcomes.

Purpose of the Study:

• To determine if the severity of pulmonary contusions correlates with adverse outcomes in severely injured patients.
• To analyze the impact of moderate to severe contusions on mortality, ventilation duration, and length of hospital stay.

Main Methods:

• Retrospective review of a chest wall injury database from a Level I trauma center.
• Inclusion criteria: Injury Severity Score (ISS) ≥ 15, chest wall Abbreviated Injury Scale (AIS) ≥ 3, mechanical ventilation > 24 hours.
• Stratification by contusion severity using AIS contusion ≥ 3 (PC-A) and Blunt Pulmonary Contusion 18 (BPC18) score ≥ 3 (PC-B).

Main Results:

• Over 5 years, 339 patients with moderate to severe contusions (PC-A/PC-B) and 211 without contusions (no-PC) were identified among severely injured patients.
• Mortality was significantly lower in PC-A (17.9%) and PC-B (17.4%) groups compared to no-PC (28.9%).
• However, PC-A and PC-B groups experienced longer mechanical ventilation (6-7 days vs 5 days), ICU stays (10 days vs 8 days), and overall hospital stays (15 days vs 13 days) compared to no-PC.

Conclusions:

• Moderate to severe pulmonary contusions are associated with increased morbidity, including prolonged mechanical ventilation and hospital length of stay, in severely injured patients.
• Despite lower mortality, contusion severity significantly impacts the clinical course of blunt chest wall injuries.
• These findings highlight the importance of assessing contusion severity in trauma management.