Multi detector computed tomography based volumetric assessment of lung parenchymal injury in isolated blunt thoracic trauma patients acts as predictor of clinical outcome: a prospective observational study

Abstract

Introduction

The role of multi detector computed tomography (MDCT) in thoracic trauma is continuously evolving with identification of occult injuries and better characterization of potentially life threatening injuries. Keeping this in mind, we have done a prospective study for volumetric analysis of lung parenchymal injury in isolated blunt thoracic trauma patients, explored its prognostic implications, and evaluated its correlation with clinical outcome of patient.

Methods

Prospective evaluation of patients with isolated blunt thoracic trauma coming from the trauma center was done with MDCT. Patients with poly trauma, pregnancy, penetrating thoracic trauma, pre-existing pulmonary or renal disease, and any other significant co-morbid medical or surgical illness and requirement of urgent thoracotomy (surgery) were excluded from the study. Data was collected regarding patient demographics, mechanism of injury, involvement of thoracic viscera and thoracic wall, uninvolved mean lung volume and overall prognosis in relation to eventless recovery, need for mechanical ventilation, and mortality which were taken as primary outcome parameters. Mean lung volumes of both lungs were compared in between groups of eventless recovery, need of mechanical ventilation and mortality with p value <0.05 considered to be significant.

Results

Sixty-two patients age range from 18 to 60 years, of blunt chest trauma were evaluated with MDCT after initial radiographs and the results were tabulated. The commonest mode of injury was motor vehicle accidents (74%). Overall mortality of thorax trauma-related death was 8% (five cases). Incidence of lung contusion was 90%, hemopneumothorax was 45%, rib fracture was 93%, cardiac injury was 1.6%, and diaphragmatic injury was 1.6%. Significant association (p < 0.05) of mortality and requirement for ventilation was found with remaining uninvolved mean volume of both lungs 1401.60±744.71 and 1676.00±360.31 cc respectively on volumetric analysis by MDCT 64-slice scan. Remaining uninvolved mean volume of both lungs 2645.00±609.57 cc on volumetric analysis by MDCT 64-slice scan was significantly associated (p < 0.05) with eventless recovery of patients.

Conclusion

Multi detector computed tomogram based calculation of uninvolved mean lung volumes following blunt thoracic trauma can help in determination of clinical outcome and requirement for mechanical ventilation. This study re-emphasizes the role of MDCT in thoracic trauma with providing help in better injury characterization and early assessment of prognostic implications. This information can act as guide to identify patients at high risk of complications, initiate early and aggressive kinetic chest therapy and explaining prognosis to patients or attendants. This study may also help in opening up other avenues for further research in thoracic trauma.

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