Quantification and Grading of Pulmonary Contusions on CT in Polytrauma Patients

BACKGROUND

Pulmonary contusion is the most common chest injury with high mortality (10–20%) in polytrauma patients [Hosseini et al]. It is a significant contributor to the risk of respiratory complications such as ARDS and pneumonia in trauma patients. According to the literature, the majority of pulmonary contusions are only apparent on a chest CT. Trauma surgeons will be able to identify high-risk populations by using computed tomography (CT) to precisely quantify pulmonary contusion. A universal technique that properly measures pulmonary contusion may improve the accuracy of predicting outcomes and assist surgeons in determining what pulmonary contusion size identifies a patient at risk for complications. Hence, we aimed to determine the relationship between the percentage of pulmonary contusion volume and patient outcomes and to formulate a severity grading scale.

METHODS:

This will be a retrospective observational study of patients admitted under Trauma Surgery Unit of Christian Medical College, Vellore. We will include polytrauma patients (>18 years of age), diagnosed to have pulmonary contusion by chest CT done within 24 hours of admission and opted for treatment under Trauma Surgery Unit.  Those patients who do not have a chest CT within 24 hours or those who died within 48 hours of admission will be excluded from the study. Non-responders and transient responders and those who have been intubated due to head injury will also be excluded from the study. Chest CT of these patients with pulmonary contusion will be analysed using AW server software available in the Department of Radiodiagnosis. Pulmonary contusion volume and total lung volume will be measured and subsequently, the percentage volume of contusions will be obtained. We will also use a simple visual assessment method to quantify contusion size into 5 scores after reviewing both the lungs as a whole. A study specific CRF will be filled, which includes demographic details, mechanism of injury, injury severity (ISS, chest AIS). We will also document the outcomes to be analysed such as oxygen requirement, mechanical ventilator application duration, length of hospital stay, length of ICU stay, pneumonia, ARDS, in-hospital mortality from the patient charts and clinical workstation.

 RESULTS:

Using multivariate analysis, we will attempt to correlate the outcomes with the pulmonary contusion volume percentage. We will then formulate a severity grading scale for the same.