title: The Prognostic Significance of Pulmonary Contusions on Initial Chest Radiographs in Blunt Trauma Patients.
abstract: OBJECTIVE
  The importance of immediate versus delayed pulmonary contusions among severely injured blunt trauma patients is unknown. We hypothesized that patients with pulmonary contusions apparent on initial chest radiographs have higher rates of mortality and acute respiratory distress syndrome than patients who have delayed radiographic changes of pulmonary contusions.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Level 1 designated trauma centre in Ontario Canada.
  
  
  METHODS
  Eligible cases were identified through the hospital trauma registry over a 5-year period. All intubated severe trauma patients (ISS ≥ 16) with a discharge diagnosis of pulmonary contusion who presented within 2 h of injury time, were included. All cases had chest CT performed within 24 h of admission with reported findings consistent with pulmonary contusions. Patients with pulmonary contusions apparent on initial chest radiographs (CXR+) were compared with patients with delayed initial radiographic findings (CXR-). Primary outcomes were assessed by logistic regression controlling for covariates of interest.
  
  
  RESULTS
  A total of 135 intubated trauma patients with pulmonary contusions were identified over the study period. Only 52% of these patients had contusions apparent on initial chest radiograph. The overall mortality was higher in CXR+ group compared with those in CXR- group (43% vs. 25% p = 0.02). In multivariable analyses controlling for injury severity, age, sex and head injury, the CXR+ group was associated with significantly increased odds of mortality and ARDS (odds ratio for CXR+ vs. CXR- 4.19, 95%CI 1.54-11.45, p < 0.01).
  
  
  CONCLUSIONS
  Amongst intubated blunt trauma patients with confirmed pulmonary contusions diagnosis, an initial chest radiograph that reveals immediate pulmonary contusion is associated with higher mortality and ARDS compared with the absence of such findings. This suggests that the initial chest radiographs have prognostic significance in relation to pulmonary contusions due to blunt trauma.
authors.affiliation: Department of Trauma Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. mikedinh74@hotmail.com.|Department of Trauma Services, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW, 2050, Australia. mikedinh74@hotmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Dinh
authors.affiliation: Emergency Department, Sunnybrook and Women's Health Sciences Centre, Sunnybrook Campus, Toronto, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Brzozowski
authors.affiliation: Department of Research Design and Biostatistics, Institute for Clinical Evaluative Sciences, Sunnybrook Campus, Toronto, ON, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.affiliation: Department of Medicine, Division of Emergency Medicine, University of Toronto, Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Schull
keywords: Chest radiograph; Pulmonary contusion; Trauma