Research Article
The Effect of Quantifying Pulmonary Contusion Extent on The Treatment Management of Blunt Chest Trauma in Children
Abstract
Objective: Post-traumatic pulmonary contusion in children is often asymptomatic at diagnosis and has a good prognosis. The aim of this study was to investigate the clinical significance of the extent of post-traumatic pulmonary contusions and evaluate the timing of complications to determine the safe follow-up period in children with lung contusions. Methods: The study included pediatric patients who presented to the emergency department after blunt chest trauma and had pulmonary contusion detected on chest computed tomography (CT) between January 2017 and January 2020. Based on the percentage of total lung capacity occupied on thorax CT, pulmonary contusions were classified as grade 1: <19% (mild), grade 2: 19%-27% (moderate) and grade 3: ≥28% (severe). The relationship between pulmonary contusion grade and pulmonary functional status; complications and intensive care admission was examined and the mean time to complication development was determined. Results: The mean extent of pulmonary contusion after trauma was 17.8±8.6% (min-max, 5-100%) and mild (grade 1) contusion was significantly associated with spontaneous breathing (p=0.009). Contusion grade was not associated with the development of atelectasis, pneumonia, pleural effusion, pneumothorax (p=0.719) or intensive care admission (p=0.176). The mean time to detection of complications (atelectasis, pneumonia, pleural effusion, pneumothorax) on chest X-ray was 6.33±3.78 days (range, 2-9 days). Conclusion: The results suggest that although no statistically significance between the extent of pulmonary contusion and complications, patients should be hospitalized for at least 48 hours, then followed-up with chest X-ray for 1 week due to possible complications after blunt chest trauma in children.
Keywords
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References
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Year 2021,
Volume: 12 Issue: 4, 714 - 719, 29.09.2021
Abstract
References
- 1) Pearson EG, Fitzgerald CA, Santore MT. Pediatric Thoracic Trauma: Current Trents. Semin Pediatr Surg. 2017; 26: 36-42. DOI:10.1053/j.sempedsurg.2017.01.007
- 2) Holmes JF, Sokolove PE, Brant WE, et al. A clinical decision rule for identifying children with thoracic injuries after blunt torso trauma. Ann Emerg Med. 2002;39:492–9. DOI:10.1067/mem.2002.122901
- 3) Allen GS, Cox CS. Pulmonary contusion in children: Diagnosis and management, South Med J. 1998;91:1099-106. DOI:10.1097/00007611-199812000-00002
- 4) Yanchar NL, Woo K, Brennan M, et al. Chest x-ray as a screening tool for blunt thoracic trauma in children. J Trauma Acute Care Surg. 2013;75:613–9. DOI:10.1097/TA.0b013e31829bb7fe
- 5) Juan AT. The lung and Pediatric Trauma. Semin PediatrSurg. 2008;17:53-9. DOI:10.1053/j.sempedsurg.2007.10.008
- 6) Allen GS, Coates NE. Pulmonary contusion: A collective review. Am Surg. 1996;62:895-900.
- 7) Bakowitz M, Bruns B, McCunn M. Acute lung injury and the acute respiratory distress syndrome in the injured patient. Scand J Trauma Resusc Emerg Med. 2012;20:54. DOI:10.1186/1757-7241-20-54
- 8) Miller PR, Croce MA, Bee TK, et al. ARDS after pulmonary contusion: accurate measurement of contusion volume ıdentifies high-risk patients. J Trauma. 2001;51:223–30. DOI:10.1097/00005373-200108000-00003
- 9) Bliss D, Silen M. Pediatric thoracic trauma. Crit Care Med. 2002;30:409–15. DOI: 10.1097/00003246-200211001-00005
- 10) Nakayama DK, Ramenofsky ML, Rowe MI. Chest injuries in childhood. Ann Surg. 1989;210:770-5. DOI: 10.1097/00000658-198912000-00013
- 11) Wagner RB, Jamieson PM. Pulmonary contusion. Evaluation and classification by computed tomography. Surg Clin North Am. 1989;69:31-40. DOI:10.1016/s0039-6109(16)44732-8
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- 13) Richardson JD, Adams L, Flint LM. Selective management of flail chest and pulmonary contusion. Ann Surg. 1982;1968:481-7. DOI:10.1097/00000658-198210000-00012
- 14) Deunk J, Poels TC, Brink M, et al. The clinical outcome of occult pulmonary contusion on multidetector-row computed tomography in blunt trauma patients. J Trauma. 2010;68:387-94. DOI:10.1097/TA.0b013e3181a7bdbd
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- 17) Beshay M, Mertzlufft F, Kottkamp HW, et al. Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: a mono-centre study. World Journal of Emergency Surgery. 2020;15:45. DOI: 10.1186/s13017-020-00324-1
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- 20) Hildebrand F, van Griensven M, Garapati R, et al. Diagnostics and Scoring in Blunt Chest Trauma. Eur J Trauma. 2002;28:157–67. DOI: 10.1007/s00068-002-1192-1
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There are 21 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 29, 2021 |
| Submission Date | June 30, 2021 |
| Published in Issue | Year 2021Volume: 12 Issue: 4 |
