Purpose: There is still much controversy regarding the optimal treatment for pulmonary contusion. Therefore, we examined the variables affecting patient outcomes over a 10-year period.
Methods: We retrospectively reviewed 107 consecutive patients with a mean age of 28 years, who were treated for pulmonary contusion during a 10-year period. Pulmonary perfusion scans were obtained for 11 patients. We used a pulmonary contusion score (PCS) of one-third of a lung = 3 and the entire lung = 9.
Results: Overall mortality was 15%, which increased to 24.4% in patients with a PCS of 7-9. The time taken for contusions to resolve was longer based on scan results than chest X-rays (42.6 vs 15.5 days, respectively). Concomitant thoracic injures were present in 64.5% of patients, and 29% had a flail chest. The factors predictive of mortality were age >/=60 years, an injury severity score (ISS) >/=25, transfusion of >/=4 units of blood, a PaO(2)/FIO(2) ratio of <300, concomitant flail chest, and a PCS of 7-9. The predictors for mechanical ventilation were age >/=60 years, concomitant flail chest, a PCS of 7-9, and an ISS >/=25. Mortality and the need for mechanical ventilation were higher in patients with nonisolated contusions than in those with isolated contusions.
Conclusions: Optimizing patient outcome requires prompt diagnosis, appropriate maintenance of fluid volume, and selective mechanical ventilation.