Pulmonary contusions: Quantifying the lesions on chest x-ray films and thefactors affecting prognosis

Objectives: To quantify pulmonary contusions on chest x-ray film and to eva luate factors correlating with the size of the pulmonary contusions, change s in the first 24 hours, the need for ventilatory assistance, and death. Methods: The medical records and chest x-ray films of 103 patients with blu nt chest trauma diagnosed as having a pulmonary contusion were reviewed. Results: A pulmonary contusion score was developed (3 = one third of a lung ; 9 = an entire lung). In the emergency department, pulmonary contusions we re not present in 11, were mild (one ninth to two ninths of a lung) in 15 p atients, moderate-severe (three ninths to nine ninths of a lung) in 53 pati ents, and very severe in 24 patients. Within 24 hours, the pulmonary contus ion score increased in 26 patients by 7.9 +/- 5.5 (SD), The 26 patients wit h an increasing contusion had a higher mortality rate (38% vs, 17%) (p = 0. 044) and tended to need ventilatory assistance more frequently (73% vs. 49% ) (p = 0.061), The 35 patients with very severe pulmonary contusions (pulmo nary contusion score = 10-18) had the lowest PaO2:FIO2 ratio at 24 hours (1 75 +/- 103 mm Hg), longest hospital length of stay (28 +/- 35 days), and th e highest Injury Severity Score (26 +/- 9). The factors correlating highest with a need for ventilatory support (57/103) were the 24 hour or initial P ao(2)/Fio(2) ratio < 300, an Injury Severity Score greater than or equal to 24, Revised Trauma Score < 6.4, Glasgow Coma Scale score less than or equa l to 12, and shock or need for blood in the first 24 hours (p < 0.001), Dea th correlated highly with a need for ventilatory assistance, Injury Severit y Score greater than or equal to 26, Revised Trauma Score less than or equa l to 6.3, and Glasgow Coma Scale score less than or equal to 11 (p < 0.001) . Conclusion: Quantifying and noting changes in the extent of the pulmonary c ontusions and Pao(2)/FIO2, ratio during the first 24 hours may be of value in determining the need for ventilatory assistance and predicting outcome.