de Moya et al identified risk factors predicting the need for mechanical ventilation for a patient with blunt pulmonary contusion. These can help to identify a patient who may benefit from more aggressive management. The authors are from Massachusetts General Hospital and Harvard Medical School.
Patient selection: blunt pulmonary contusion
Parameters:
(1) Glasgow Coma Score (GCS)
(2) number of fractured ribs
(3) number of lung fields (out of 6) showing any evidence of opacification on the admission chest X-ray (using the BPC6, see below)
Parameter |
Finding |
Points |
Glasgow Coma Score |
14 or 15 |
0 |
|
3 to 13 |
1 |
number of fractured ribs |
0 to 4 |
0 |
|
>= 5 |
1 |
contusion on chest X-ray |
0, 1 or 2 (out of 6) |
0 |
|
>= 3 (out of 6) |
1 |
where:
• The odds ratio for mechanical ventilation was 118 for GCS, 9 for fractured ribs and 13 for contusion on chest X-ray (Table 4, page 1545). Therefore, GCS needs to be weighted more if 1 or 2 factors are present.
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• The higher the score the more likely that mechanical ventilation will be needed.
• Patients with all 3 factors usually required mechanical ventilation.
• Patients with none of the risk factors did not require mechanical ventilation 100% of the time.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general, Cardiology
ICD-10: ,