Risk Factors Affecting the Prognosis in Patients with Pulmonary Contusion Following Chest Trauma OC17-OC19
Dr. Gaude Gajanan,
Professor and Head, Department of Pulmonary Medicine,
KLE Universityâ€™s J. N. Medical College, Belgaum, Karnataka-590010, India.
Introduction: Thoracic injury and its complications are responsible for as much as 25% for blunt trauma mortality. Pulmonary contusion occurs in 30%â€“75% of these cases. Despite advances in pulmonary care and intensive care management pulmonary contusion still contributes to higher mortality and morbidity for patients with severe injuries.
Aim: To assess the outcome of pulmonary contusions in patients with chest trauma and various factors determining mortality in these patients.
Materials and Methods: A retrospective case study, over a period of one year, of all chest trauma cases with pulmonary contusions confirmed by X-rays or CT scan of thorax, were included in the study. All the cases were assessed for age, associated injuries, APACHE II score, SAPS II score, SOFA score, paO2/Fio2 ratio, fracture of ribs, presence of haemothorax or pneumothorax, ventilator and ICU days and finally hospital outcome.
Results: A total of 16 cases of pulmonary contusions were included in the study. Five patients died during the ICU stay and 11 survived. All patients had associated injuries. There was significant difference seen in APACHE II score (p<0.001), SAPS II score (p<0.001), SOFA score (p<0.001), paO2/Fio2 ratio (p<0.022) and ventilator days (p<0.001) among the survivors and non-survivors. However, no significant difference was seen in presence of fracture of ribs and presence of either haemothorax or pneumothorax.
Conclusion: The risk factors that were associated with higher mortality in patients with pulmonary contusions following chest trauma were APACHE II score, SAPS II score, SOFA score, paO2/Fio2 ratio and ventilator days. Close monitoring to improve the gas exchange and better fluid management will help in improving the survival in these patients.