The effect of quantifying pulmonary contusion extent on the treatment management of blunt chest trauma in children

Objective: Post-traumatic pulmonary contusion in children is often asymptomatic at diagnosis and has a good prognosis. The aim of this study was to investigate the clinical significance of the extent of post-traumatic pulmonary contusions and evaluate the timing of complications to determine the safe follow-up period in children with lung contusions. Methods: The study included pediatric patients who presented to the emergency department after blunt chest trauma and had pulmonary contusion detected on chest computed tomography (CT) between January 2017 and January 2020. Based on the percentage of total lung capacity occupied on thorax CT, pulmonary contusions were classified as grade 1: <19% (mild), grade 2: 19%-27% (moderate) and grade 3: ≥28% (severe). The relationship between pulmonary contusion grade and pulmonary functional status; complications and intensive care admission was examined and the mean time to complication development was determined. Results: The mean extent of pulmonary contusion after trauma was 17.8±8.6% (min-max, 5-100%) and mild (grade 1) contusion was significantly associated with spontaneous breathing (p=0.009). Contusion grade was not associated with the development of atelectasis, pneumonia, pleural effusion, pneumothorax (p=0.719) or intensive care admission (p=0.176). The mean time to detection of complications (atelectasis, pneumonia, pleural effusion, pneumothorax) on chest X-ray was 6.33±3.78 days (range, 2-9 days). Conclusion: The results suggest that although no statistically significance between the extent of pulmonary contusion and complications, patients should be hospitalized for at least 48 hours, then followed-up with chest X-ray for 1 week due to possible complications after blunt chest trauma in children.