Pulmonary contusion in ballistic injuries and peacetime mechanical traumas

Abstract

Pulmonary contusion presents the most common, but highly controversial chest injury when diagnosed; however, the data on pulmonary contusion rate found in Russian and foreign literature is rather scarce. Pulmonary contusion rate was stated to be 30,6% among casualties with associated mechanical traumas, and 50,6% for associated chest trauma. In its turn it was 4,3% for ballistic injuries, whereas the rate amounted up to 15,7% for injuries with the leading chest trauma. It should be stressed that chest ballistic injuries accompanied by pulmonary contusion when compared with mechanical traumas were characterized by more massive lung parenchyma damage, and the proportion of extensive pulmonary contusion reached 66,1%. Among ballistic injuries with pulmonary contusion blast trauma constituted 15,4%, fragment wounds – 32%, bullet wounds – 52,6%. The group of blast trauma casualties with pulmonary contusion appeared to demonstrate the most severe condition. This group was characterized by high complication rate (56,5%) and lethal outcomes (65,2%). The injury severity, however, was determined mainly by extrathoracic injuries, chest trauma being leading only in 17,4% of cases, and the proportion of extensive pulmonary contusion reached 44,6%. The group of pulmonary contusion casualties with associated fragment wounds when compared with blast wounds, were characterized by the decrease in total rate of injury severity and the increase in chest trauma severity, the chest being the leading damage area in 45,1% of cases. Chest injuries were penetrating in 90% of cases, being characterized by the significant increase in hemopneumothorax rate (by 5 times) and continuing intrapleural hemorrhage (by 4 times). The complication rate reached 66,6%, the proportion of pulmonary complications constituted 25,5%, the lethality rate was noted to decrease down to 25,5%. Pulmonary contusion associated with bullet wounds proved to be the most severe. It was significantly characterized by higher score according to the unbiased chest trauma diagnosis scale «Military field surgery – lung contusion» – 20,1±3,1, and by chest trauma severity score according to the scale «Military field surgery – injury gunshot wounds» – 5,8±0,6. The proportion of extensive pulmonary contusion in pleuropulmonary complications is 37,2%, the lethality rate increased up to 32,1%.