Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 7 , ISSUE 2 ( May-August, 2018 ) > List of Articles

RESEARCH ARTICLE

Closed (Blunt) Compared to Open (Penetrating) Pulmonary Contusion–A National Trauma Data Bank Review

Mauricio Lynn, Nicholas Namias, George D Garcia, Enrique Ginzburg, Carl Schulman, Edward Lineen, Louis Pizano, Antonio Marttos, Gabriel Ruiz, Tanya Zakrison, Valerie Hart, Joyce Kaufman, Rishi Rattan, Howard Lieberman, Patricia M Byers, Danny Sleeman

Keywords : Chest trauma, ICU, Lung, Mortality, Penetrating, Pulmonary contusion (blunt, closed, open)

Citation Information : Lynn M, Namias N, Garcia GD, Ginzburg E, Schulman C, Lineen E, Pizano L, Marttos A, Ruiz G, Zakrison T, Hart V, Kaufman J, Rattan R, Lieberman H, Byers PM, Sleeman D. Closed (Blunt) Compared to Open (Penetrating) Pulmonary Contusion–A National Trauma Data Bank Review. Panam J Trauma Crit Care Emerg Surg 2018; 7 (2):102-107.

DOI: 10.5005/jp-journals-10030-1212

License: CC BY-NC 4.0

Published Online: 01-08-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Pulmonary contusion is a common injury and may occur in blunt or penetrating trauma patients. These injury mechanisms may have a distinct pathophysiology, differ in the out come and may require individualized treatment. The purpose of this study is to compare these two mechanisms of pulmonary contusion in respect to outcome and clinical management. Methods of Research: The 2012 National Trauma Data Bank (NTDB) was queried for open and closed pulmonary contusion utilizing ICD-9 codes 861.31 and 861.21. Data for both groups were analyzed with t-test for numerical data and chi-square for categorical data utilizing SPSSTM and Vassar StatsTM. Results: A total of 12,884 patients with pulmonary contusions were identified. The closed pulmonary contusion was present in 12,329 patients, open pulmonary contusion in 555 patients. Patients with closed pulmonary contusions were older with a mean age of 38.00 ± 22.23 versus 30.58 ± 12.88. Patients with closed pulmonary contusion had a higher injury severity score (ISS) 21.60 ± 0.22 versus 18.64 ± 1.08, p = 0.001. Closed pulmonary contusion was associated with increased ventilator days 3.09 ± 0.13, p = 0.052, intensive care unit (ICU) days 5.11 ± 0.15 versus 4.01 ± 0.69, p = 0.003 and hospital length of stay 0.65 ± 0.25 versus 9.37 ± 0.99, p = 0.032. Conclusion: Blunt (closed) pulmonary contusion is more prevalent than open (penetrating) pulmonary contusion and is associated with a higher injury severity score (ISS). Closed pulmonary contusion shows a tendency towards more extended mechanical ventilation time and is associated with a longer ICU stay, hospital length of stay and mortality. These findings might be secondary to associated chest wall trauma and other organ system injuries or secondary to the volume size of involved lung parenchyma. A pulmonary contusion may be a different entity compared to penetrating pulmonary contusion with different patient demographics, care requirements and outcome. Additional research is required to better understand contributing factors, differences in pathophysiology and clinical management of these two different disease processes.


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  1. Cohn SM. Pulmonary contusion: Review of the clinical entity. J Trauma. 1997;42(5):973-979.
  2. Simon B, Ebert J, Bokhari F, Capella J, Emhoff T, Hayward T, 3rd, et al. Management of pulmonary contusion and flail chest: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S351-S361.
  3. Battle CE, Evans PA. Predictors of mortality in patients with flail chest: A systematic review. Emerg Med J. 2015;32(12):961-965.
  4. Deunk J, Poels TC, Brink M, Dekker HM, Kool DR, Blickman JG, et al. The clinical outcome of occult pulmonary contusion on multidetector-row computed tomography in blunt trauma patients. J Trauma. 2010;68(2):387-394.
  5. Surgeons ACo. National Sample Program 2012 User Manual. www.ntdborg/nsp. 2013.
  6. Perl M, Gebhard F, Bruckner UB, Ayala A, Braumuller S, Buttner C, et al. Pulmonary contusion causes impairment of macrophage and lymphocyte immune functions and increases mortality associated with a subsequent septic challenge. Crit Care Med. 2005;33(6):1351-1358.
  7. Hoth JJ, Wells JD, Yoza BK, McCall CE. Innate immune response to pulmonary contusion: Identification of cell type-specific inflammatory responses. Shock. 2012;37(4):385-391.
  8. Cohn SM, Dubose JJ. Pulmonary contusion: An update on recent advances in clinical management. World J Surg. 2010;34(8):1959-1970.
  9. Allen GS, Coates NE. Pulmonary contusion: A collective review. Am Surg. 1996;62(11):895-900.
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