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Am J Surg. 2019 Jan 30. pii: S0002-9610(17)31051-6. doi: 10.1016/j.amjsurg.2019.01.027. [Epub ahead of print]

Impact of blunt pulmonary contusion in polytrauma patients with rib fractures.

Author information

1
Section of Trauma and Acute Care Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA.
2
Department of Radiology, Albany Medical Center, Albany, NY, USA.
3
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
4
Division of Acute Care Surgery and Surgical Critical Care, Houston Methodist Hospital, Houston, TX, USA.
5
Section of Trauma and Acute Care Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA. Electronic address: tafenwm@mail.amc.edu.

Abstract

BACKGROUND:

We investigated the impact of blunt pulmonary contusion (BPC) in patients with rib fractures.

METHODS:

Adult patients with rib fractures caused by blunt mechanisms were enrolled over 3 years at a Level 1 trauma center. BPC was defined according to percentage of lung affected as: moderate (1-19% contusion) or severe (≥20% contusion).

RESULTS:

In total, 1448 of the 7238 admitted patients had rib fractures. Of these, 321 (22.2%) had BPC: 236 moderate and 85 severe. Patients with BPC were more likely to be admitted to the ICU (moderate: OR 1.55, 95% CI 1.10-2.19; severe: OR 2.74, 95% CI 1.41-5.32). Significantly increased rates of pneumonia (OR 2.52, 95% CI 1.43-4.90) and empyema (OR 4.80, 95% CI 1.07-21.54) were found for moderate and severe BPC, respectively.

CONCLUSIONS:

ICU admission and infectious pulmonary complications were more likely with BPC. The presence of BPC on admission CT is also prognostic of increased resource utilization.

KEYWORDS:

Blunt chest trauma; Polytrauma; Pulmonary contusion; Rib fractures

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