Pulmonary contusion epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Epidemiology and Demographics
Pulmonary contusion is found in 30–75% of severe cases of chest injury, making it the most common serious injury to occur in association with thoracic trauma. Miller DL, Mansour KA (2007). "Blunt traumatic lung injuries". Thoracic Surgery Clinics. 17 (1): 57–61. doi:10.1016/j.thorsurg.2007.03.017. PMID 17650697. </ref> Of people who have multiple injuries with an injury severity score of over 15, pulmonary contusion occurs in about 17%. It is difficult to determine the death rate (mortality) because pulmonary contusion rarely occurs by itself. Usually, deaths of people with pulmonary contusion result from other injuries, commonly traumatic brain injury. It is controversial whether pulmonary contusion with flail chest is a major factor in mortality on its own or whether it merely contributes to mortality in people with multiple injuries. The mortality rate of pulmonary contusion is estimated to range from 14–40%, depending on the severity of the contusion itself and on associated injuries. When the contusions are small, they do not normally increase the chance of death or poor outcome for people with blunt chest trauma; however, these chances increase with the size of the contusion. One study found that 35% of people with multiple significant injuries including pulmonary contusion die. In another study, 11% of people with pulmonary contusion alone died, while the number rose to 22% in those with additional injuries. An accompanying flail chest increases the morbidityand mortality to more than twice that of pulmonary contusion alone. Pulmonary contusion is thought to be the direct cause of death in a quarter to a half of people with polytrauma who die.
Pulmonary contusion is the most common cause of death among vehicle occupants involved in accidents,[1] and it is thought to contribute significantly in about a quarter of deaths resulting from vehicle collisions. As vehicle use has increased, so has the number of auto accidents, and with it the number of chest injuries. However an increase in the number of airbags installed in modern cars may be decreasing the incidence of pulmonary contusion. Use of child restraint systems has brought the approximate incidence of pulmonary contusion in children in vehicle accidents from 22% to 10%.
Cullen ML (2001). "Pulmonary and respiratory complications of pediatric trauma". Respiratory Care Clinics of North America. 7 (1): 59–77. PMID 11584805. Unknown parameter |month= ignored (help)
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Since their chest walls are more flexible, children are more vulnerable to pulmonary contusion than adults are, and it is more common in children than in adults for that reason.
Matthay RA, George RB, Light RJ, Matthay MA, ed. (2005). "Thoracic trauma, surgery, and perioperative management". Chest Medicine: Essentials of Pulmonary and Critical Care Medicine. Hagerstown, MD: Lippincott Williams & Wilkins. p. 578. ISBN 0-7817-5273-6.</ref> Children in forceful impacts suffer twice as many pulmonary contusions as adults with similar injury mechanisms, yet have proportionately fewer rib fractures. Pulmonary contusion has been found in 53% of children with significant chest injuries (those requiring hospitalization).[2] The rates of certain types of injury mechanisms differ between children and adults; for example, children are more often hit by cars when they are pedestrians. Differences in the bodies of children and adults also lead to different manifestations of pulmonary contusion and associated injuries; for example, children have less body mass, so the same force is more likely to lead to trauma to multiple body systems. Some differences in children's physiology might be advantageous (for example they are less likely to have other medical conditions), and thus they have been predicted to have a better outcome.
Allen GS, Cox CS, Moore FA, Duke JH, Andrassy RJ (1997). "Pulmonary contusion: Are children different?". Journal of the American College of Surgeons. 185 (3): 229–233. PMID 9291398. Unknown parameter |month= ignored (help)</ref> However, despite these differences, children with pulmonary contusion have similar mortality rates to adults.
References
- ↑ Milroy CM, Clark JC (2000). "Injuries and deaths in vehicle occupants". In Mason JK, Purdue BN. The Pathology of Trauma. Arnold. p. 10. ISBN 0-340-69189-1.
- ↑ Nakayama, DK (December 1989). "Chest injuries in childhood". Annals of Surgery. 210 (6): 770–775. PMID 2589889. Unknown parameter
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