To determine outcome in young, healthy blunt trauma patients with isol
ated pulmonary contusion, and to identify factors associated with poor
outcome, we reviewed 6012 consecutive adult (aged 16-49) blunt trauma
admissions. Ninety-four (7.9%) presented with an isolated pulmonary c
ontusion defined by chest radiograph and Injury Severity Score <25; th
ey compromise the study group. Poor outcome was defined as death, prol
onged hospitalization (>7 days), or a severe complication (pneumonia,
empyema, atelectasis requiring bronchoscopy, or bronchopleural fistula
). None of the 94 study patients died. Admission chest radiograph demo
nstrated no contusion in 34 patients (36%). Fifteen patients (16%) req
uired intubation, but 13 were extubated within 48 hours. Forty-one pat
ients (44%) required insertion of a chest tube, and 20 patients (21%)
had a PaO2/F1O2 ratio of <250 on admission. Post-injury atelectasis (n
= 17), pneumothorax (n = 17), effusion (n = 8), pneumonia (n = 2), em
pyema (n = 1), and Staphylococcal bacteremia (n = 1) complicated hospi
talizations. The following clinical factors were identified as predisp
osing to poor outcome by univariate analysis: 1) Pulmonary contusion o
n admission chest radiograph (P = 0.035); 2) Three or more rib fractur
es (P = 0.002); 3) chest tube insertion (P = 0.010) and drainage (P =
0.020); and 4) hypoxia on admission (PO2 < 70 torr [P =.021], FaO2/F1O
2 < 250 [P < 0.001]). Only PaO2/F1O2 < 250 on admission was an indepen
dent predictor of poor outcome in a multivariate analysis (P = 0.040).
Our conclusion was that isolated pulmonary contusion in young, health
y patients is not associated with mortality. Only PaO2/F1O2 < 250 on a
dmission was an independent predictor of poor outcome. Early identific
ation of hypoxia may guide aggressive treatment to prevent complicatio
ns.