Document Detail


An innovative approach to predict the development of adult respiratory distress syndrome in patients with blunt trauma.
MedLine Citation:
PMID:  22914080     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pulmonary contusion (PC) is a common injury associated with blunt chest trauma. Complications such as pneumonia and adult respiratory distress syndrome (ARDS) occur in up to 50% of patients with PC. The ability to predict which PC patients are at increased risk of developing complications would be of tremendous clinical utility. In this study, we test the hypothesis that a novel method that objectively measures percent PC can be used to identify patients at risk to develop ARDS after injury.
METHODS: Patients with unilateral or bilateral PC with an admission chest computed tomographic angiogram were identified from the trauma registry. Demographic, infectious, and outcome data were collected. Percent PC was determined on admission chest computed tomography using our novel semiautomated, attenuation-defined computer-based algorithm, in which the lung was segmented with minimal manual editing. Factors contributing to the development of ARDS were identified by both univariate and multivariable logistic regression analyses. ARDS was defined as PaO2/FiO2 ratio of less than 200 with diffuse bilateral infiltrates on chest radiograph with no evidence of congestive heart failure.
RESULTS: Quantifying percent PC from our objective computer-based approach proved successful. We found that a contusion size of 24% of total lung volume or greater was most significant at predicting ARDS, which occurred in 78% of these patients. Such patients also had a significantly higher incidence of pneumonia when compared with those with contusions less than 24%. The specificity of contusion size of 24% or greater was 94%, although sensitivity was 37%; positive predictive value was 78%, and negative predictive value was 72%.
CONCLUSION: We developed and describe a software-based methodology to accurately measure the size of lung contusion in patients of blunt trauma. In our analyses, contusions of 24% or greater most significantly predict the development of ARDS. Such an objective approach can identify patients with PC who are at increased risk for developing respiratory complications before they happen. Further research is needed to use this novel methodology as a means to prevent posttraumatic lung injury in patients with blunt trauma.
LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III; diagnostic study, level IV.
Authors:
Robert D Becher; Alexander L Colonna; Toby M Enniss; Ashley A Weaver; Daniel K Crane; R Shayn Martin; Nathan T Mowery; Preston R Miller; Joel D Stitzel; J Jason Hoth
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  73     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-02     Completed Date:  2013-02-11     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1229-35     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Algorithms*
Diagnosis, Computer-Assisted*
Female
Humans
Logistic Models
Lung Injury / complications*,  physiopathology,  radiography
Male
Middle Aged
Predictive Value of Tests
Respiratory Distress Syndrome, Adult / diagnosis*,  etiology*
Risk Factors
Tomography, X-Ray Computed
Trauma Severity Indices
Wounds, Nonpenetrating / complications*,  physiopathology,  radiography
Young Adult
Grant Support
ID/Acronym/Agency:
NIH-GM083154/GM/NIGMS NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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