Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, CO, USA.
Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
Am Surg. 2024 Feb;90(2):261-269. doi: 10.1177/00031348231198111. Epub 2023 Aug 30.
The progression of pulmonary contusions remains poorly understood. This study aimed to measure the radiographic change in pulmonary contusions over time and evaluate the association of the radiographic change with clinical outcomes and surgical stabilization of rib fractures (SSRF).
This retrospective cohort study included adults admitted with three or more displaced rib fractures or flail segment on trauma CT and when a chest CT was repeated within one week after trauma. Radiographic severity of pulmonary contusions was assessed using the Blunt Pulmonary Contusion Score (BPC18). Logistic regression was performed to evaluate the relation between SSRF and worsening contusions on repeat CT, adjusted for potential confounders.
Of 231 patients, 56 (24%) had a repeat CT scan. Of these, 55 (98%) had pulmonary contusion on the first CT scan with a median BPC18 score of 5 (P-P 3-7). Repeat CTs showed an overall decrease of the median BPC18 score to 4 (P-P 2-6, = .02), but demonstrated a worsening of the pulmonary contusion in 16 patients (29%). All repeat CTs conducted within 12 hours post-injury demonstrated increasing BPC18. Radiographic worsening of pulmonary contusions was not associated with SSRF, nor with worse respiratory outcomes or intensive care length of stay, compared to patients with radiographically stable or improving contusions.
In patients with severe rib fracture patterns who undergo repeat imaging, pulmonary contusions are prevalent and become radiographically worse within at least the first 12 hours after injury. No association between radiographic worsening and clinical outcomes was found.
肺挫伤的进展仍知之甚少。本研究旨在测量肺挫伤随时间的放射学变化，并评估放射学变化与临床结果和肋骨骨折手术固定（SSRF）的关系。
这是一项回顾性队列研究，纳入了因多处移位性肋骨骨折或创伤 CT 上的连枷段而入院的成年人，并且在创伤后一周内重复进行胸部 CT 检查。使用钝性肺挫伤评分（BPC18）评估肺挫伤的放射学严重程度。采用逻辑回归评估 SSRF 与重复 CT 上挫伤恶化之间的关系，并对潜在混杂因素进行调整。
在 231 名患者中，有 56 名（24%）进行了重复 CT 扫描。其中，55 名（98%）在第一次 CT 扫描时存在肺挫伤，中位数 BPC18 评分为 5（P-P 3-7）。重复 CT 显示中位数 BPC18 评分总体下降至 4（P-P 2-6， =.02），但有 16 名患者（29%）的肺挫伤恶化。所有在受伤后 12 小时内进行的重复 CT 均显示 BPC18 增加。与影像学稳定或改善的挫伤患者相比，肺挫伤的影像学恶化与 SSRF 或更差的呼吸结局或 ICU 住院时间无相关性。
在接受重复成像的严重肋骨骨折模式患者中，肺挫伤很常见，并且在受伤后至少 12 小时内放射学上变得更糟。未发现放射学恶化与临床结果之间存在关联。
