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.