PREDICTORS OF MORTALITY IN PULMONARY CONTUSION

BACKGROUND: Associated injuries and central nervous system (CNS) traum a are historically associated with poor outcome in patients with pulmo nary contusions, but the value of specific factors reflecting shock, f luid resuscitation requirement and pulmonary parenchymal injury in pre dicting mortality in this population is not well established. METHODS: The medical records of 100 consecutive patients with pulmonary contus ion, admitted over a 5-year period, were retrospectively reviewed. Sur vivors and nonsurvivors were compared in terms of age, Injury Severity Score (ISS), Glasgow Coma Score (GCS), PaO2/FiO(2) (oxygenation ratio ), the severity and adequacy of shock resuscitation reflected in plasm a lactate, resuscitation volume and transfusion requirements, using on e-way ANOVA. To determine the contribution of individual, interdepende nt variables to mortality, the data were then analyzed using multivari able analysis. RESULTS: ISS and transfusion requirement were significa ntly higher, and GCS and PaO2/FiO(2) at 24 and 48 hours after admissio n were significantly lower in nonsurvivors than in survivors. After mu ltiple regression analysis, the factors most strongly associated with mortality included patient age, oxygenation ratio at 24 hours after ad mission, and resuscitation volume. CONCLUSIONS: Outcome in patients wi th pulmonary contusion is dependent upon a number of variables includi ng the severity of pulmonary parenchymal injury as reflected in PaO2/F iO(2) ratio.