Pulmonary contusions in patients with rib fractures: The need to better classify a common injury

BackgroundPulmonary contusions are common injuries. Computed tomography reveals vast contused lung volume spectrum, yet pulmonary defined dichotomously (unilateral vs bilateral). We assessed whether there is stepwise increased risk of complications among patients without, with unilateral, and bilateral contusion.MethodsWe identified adults admitted rib fractures using the largest US inpatient database. After propensity-score-matching without unilateral adjusting for residual confounders, we compared pneumonia, ventilator-associated pneumonia (VAP), respiratory failure, intubation, mortality.ResultsAmong 148,140 encounters multiple fractures, 19% had concomitant contusions. Matched [95%CI:16–33%], failure 40% [95%CI: 31–50%], intubation 46% 33–61%]. Delineation showed contusions, not attributed to complications.ConclusionsThere likely a correlation between complications; classifying insufficient. Better understanding this requires establishing clinically significant contusion correspondingly refined classification system.