The clinical benefit of a follow-up thoracic computed tomography scan regarding parenchymal lung injury and acute respiratory distress syndrome in polytraumatized patients

J Crit Care. 2017 Feb;37:211-218. doi: 10.1016/j.jcrc.2016.10.003. Epub 2016 Oct 12.

Abstract

Purpose: To evaluate the increase of parenchymal lung injury (PLI) volume between the initial and a follow-up computed tomography (CT) scan and to ascertain which of the 2 scans was more appropriate to predict acute respiratory distress syndrome (ARDS).

Material and methods: From 2011 to 2015, polytraumatized patients (≥18 years; ISS ≥ 16) directly admitted to our level I trauma center were included in our prospective study if a follow-up CT scan was possible 24 to 48 hours after the trauma. The PLI volume was measured using volumetric analysis. Statistical calculations were performed to identify patients at risk for ARDS.

Results: One hundred thirty patients (mean age, 41.3 years; mean ISS, 31.9) met the inclusion criteria. Median relative PLI volume was higher in the follow-up than in the initial CTs (9.65% vs 4.84%; P = .001). The ARDS developed in 42 patients (32.3%). Their initial PLI volume was higher compared with those without ARDS (11.23% vs 2.14%; P < .0001). The ARDS incidence increased with increasing initial PLI volume. Receiver operating characteristic statistics identified initial (area under the curve = 0.753) and follow-up relative PLI volume as a predictor for ARDS (area under the curve = 0.725).

Conclusions: The CT scans performed directly after admission are sufficient to define patients at risk for ARDS. Therefore, solely the incidence of PLI does not justify a routine follow-up CT scan.

Keywords: ARDS; Follow-up CT scan; Parenchymal lung injury; Polytraumatized patients; Volumetric analysis.

MeSH terms

  • Adult
  • Aftercare
  • Female
  • Humans
  • Injury Severity Score
  • Lung / diagnostic imaging*
  • Lung Injury / complications
  • Lung Injury / diagnostic imaging*
  • Male
  • Middle Aged
  • Multiple Trauma / diagnostic imaging*
  • Prospective Studies
  • ROC Curve
  • Respiratory Distress Syndrome / diagnostic imaging*
  • Respiratory Distress Syndrome / epidemiology
  • Respiratory Distress Syndrome / etiology
  • Risk Assessment
  • Tomography, X-Ray Computed
  • Trauma Centers
  • Young Adult