The Value of Grading of Pulmonary Contusion by the Chest CT Scanning

ABSTRACT

PURPOSE: Pulmonary contusion is the most common injury in patients with blunt chest trauma, and reported as 15~20% of multiple traumatic patients. In this study, we would like to predict a prognosis for pulmonary contusion easily at ED through the chest CT scanning. METHODS: We reviewed medical records and chest CT findings of 190 pulmonary contusion patients retrospectively. Both lung were devided into 4 areas, RUL +RML, RLL, LUL, and LLL (RUL right upper lobe, RMLright middle lobe, LULleft upper lobe, LLL left lower lobe). 3 point were given to each area, maximally. In each area, a ratio was measured as the longest pulmonary contusion length per the transverse axis length of lung on the largest pulmonary contusion image of chest CT scan. The score can be obtained by multiplying 3 to the ratio and raising fractions not lower than 0.5 to a unit. We classified to three groups as mild (PCS 0-2), moderate (3-5), and severe (6-12) PCS groups. RESULTS: 179 patients with pulmonary contusion were classified as 94 mild, 52 moderate, 33 severe pulmonary contusion groups by PCS. As PCS was high, PRF (Pao2/ FiO2) was decreasing, number of patients treated with mechanical ventilation was increasing, ICU stay was long, and a complication rate was increasing. CONCLUSION: For patients with blunt chest trauma at ED which classified as severe PCS group (6-12), the patients need ICU admission and active treatment for a long time to reduce the mortality and complication rate.