Determinants of outcome after pulmonary contusion

During the past 5 1/2 years, 86 patients were treated for pulmonary contusion resulting from blunt trauma. Injury mechanism was motor vehicle in 65 patients (76%), farming in nine (10%), fall in eight (9%), and miscellaneous in four (5%). There were 68 males (79%) and 18 females. Ages ranged from 4 to 75 years (mean, 32 years). Twenty-two patients (26%) presented in hypovolemic shock. Injury Severity Score (ISS) averaged 26 (range, 9-57). Intubation was performed in the Emergency Department in 21 patients (24%), 19 of whom were severely hypoxic with pO2/FIO2 ratio less than 300. Thirty-four patients were ultimately treated with mechanical ventilation for 1 to 103 days (mean, 9.1 days). The average hospital stay was 22 days. Eleven patients (13%) died. Mortality was significantly greater (p less than 0.05) in patients with ISS greater than or equal to 25, initial Glasgow Coma Scale less than or equal to 7, transfusion of greater than three units of blood, and pO2/FIO2 less than 300. Mortality was not correlated with either presence of shock or amount of intravenous fluid administration. Eighteen patients with concomitant flail chest demonstrated no increase in mortality but were likely to require mechanical ventilation (p less than 0.05). The extent of contusion assessed on admission chest roentgenogram was not predictive of mortality or need for intubation. We recommend aggressive treatment of associated injuries, craniocerebral trauma, and selective mechanical ventilation based upon degree of intrapulmonary shunt.