Pulmonary contusions in the elderly after blunt trauma: incidence and outcomes

Background: In the general population with blunt chest trauma, pulmonary contusions (PCs) are commonly identified. However, there is limited research in the elderly. We sought to evaluate the incidence and outcomes of PCs in elderly blunt trauma admissions. Methods: We retrospectively reviewed the trauma registry at a level I trauma center for all blunt thoracic trauma patients aged ≥65 y, who were admitted between 2007 and 2015. The medical records of PC patients were reviewed. Results: There were 956 admissions with blunt thoracic trauma; of which 778 had no pulmonary contusion (NO) and 178 had PC. The major mechanisms of injury were falls (58.7% NO, 39.3% PC, P <0.001) and motor vehicle crash/motor cycle crash (35.6% NO, 51.7% PC, P <0.001). Rib fractures were present in 79.8% of PC and 73.8% of NO patients, P = 0.1. PC patients more often had serious (AIS ≥3) head/neck (30.3% versus 20.6%, P <0.001), abdomen (12.4% versus 6.6%, P <0.001), and extremity injuries (20.8% versus 11.4%, P <0.001). Complication (46.1% PC versus 26.6% NO, P <0.001) and mortality (14.0% PC versus 6.2% NO, P = 0.0003) rates were higher in PC patients. On multivariate logistic regression analyses, PC presence was significantly associated with mechanical ventilation (odds ratio 2.5), intensive care unit admission (odds ratio 2.3), and mortality (odds ratio 1.9). Conclusions: Over 18.6% of elderly blunt thoracic trauma patients sustained PC, despite an often low energy mechanism of injury. The presence of a PC should prompt investigation for other serious intrathoracic and extrathoracic injuries. PC presence is associated with substantial morbidity and mortality.