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Differences in clinical characteristics and outcomes for blunt versus penetrating traumatic pulmonary pseudocysts
Traumatic pulmonary pseudocysts (TPPs) are under-reported in blunt trauma and rarely reported in penetrating trauma. Little is known about the impact of injury mechanism on the pathophysiology or the risk factors that predispose to worse patient outcomes. We hypothesized that blunt and penetrating T...
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| Published in: | The American journal of emergency medicine 2021-07, Vol.45, p.433-438 |
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| container_title | The American journal of emergency medicine |
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| creator | Beattie, Genna Cohan, Caitlin M. Tang, Annie Yasumoto, Eric Victorino, Gregory P. |
| description | Traumatic pulmonary pseudocysts (TPPs) are under-reported in blunt trauma and rarely reported in penetrating trauma. Little is known about the impact of injury mechanism on the pathophysiology or the risk factors that predispose to worse patient outcomes. We hypothesized that blunt and penetrating TPPs have different clinical characteristics and outcomes.
Computed tomography imaging was evaluated for patients presenting at a level 1 trauma center with confirmed TPP from 2011 to 2018. Diameter was determined by largest dimension of the dominant TPP. Clinical variables and TPP features were compared for blunt versus penetrating trauma by using comparative statistics and multivariable analysis.e
A total of 101 TPP patients were identified (blunt = 64; penetrating = 37). In penetrating TPP, rates of concomitant pulmonary laceration, hemothorax, and pneumothorax, were, respectively, 4.5, 3.1, and 1.4 times higher than for blunt TPP. Concomitant rib fracture was twice as common in blunt TPP as in penetrating TPP (69% versus 32%). For penetrating injury, the risk of complications related to TPP was increased (aOR = 5.3), specifically persistent/recurrent pneumothorax (aOR = 10.4). All deaths resulted from pulmonary hemorrhage (blunt = 3, penetrating = 2). Regardless of mechanism, air-fluid level and hemoptysis correlated with death (p |
| doi_str_mv | 10.1016/j.ajem.2020.09.048 |
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Computed tomography imaging was evaluated for patients presenting at a level 1 trauma center with confirmed TPP from 2011 to 2018. Diameter was determined by largest dimension of the dominant TPP. Clinical variables and TPP features were compared for blunt versus penetrating trauma by using comparative statistics and multivariable analysis.e
A total of 101 TPP patients were identified (blunt = 64; penetrating = 37). In penetrating TPP, rates of concomitant pulmonary laceration, hemothorax, and pneumothorax, were, respectively, 4.5, 3.1, and 1.4 times higher than for blunt TPP. Concomitant rib fracture was twice as common in blunt TPP as in penetrating TPP (69% versus 32%). For penetrating injury, the risk of complications related to TPP was increased (aOR = 5.3), specifically persistent/recurrent pneumothorax (aOR = 10.4). All deaths resulted from pulmonary hemorrhage (blunt = 3, penetrating = 2). Regardless of mechanism, air-fluid level and hemoptysis correlated with death (p < 0.02) and all patients with hemoptysis required pulmonary intervention (p = 0.0001).
Penetrating TPPs demonstrate a unique pattern of concurrent lung injury and increased complication risk. Importantly, severe hemoptysis and air-fluid level may indicate risk of impending morbidity and mortality regardless of injury mechanism and should serve as an early warning sign for the trauma physician.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2020.09.048</identifier><language>eng</language><publisher>Philadelphia: Elsevier Inc</publisher><subject>Computed tomography ; Contusions ; Cysts ; Emergency medical care ; Hemoptysis ; Hemorrhage ; Hemothorax ; Infections ; Injuries ; Intervention ; Intubation ; Lungs ; Morbidity ; Ostomy ; Patients ; Pneumothorax ; Risk factors ; Statistical analysis ; Thoracic trauma ; Trauma ; Traumatic pneumatocele ; Traumatic pulmonary pseudocyst</subject><ispartof>The American journal of emergency medicine, 2021-07, Vol.45, p.433-438</ispartof><rights>2020 Elsevier Inc.</rights><rights>2020. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c361t-88b3c07ffecb6e82ec09c86b14abf897472d0d547f707698d5a656cd9b4177363</citedby><cites>FETCH-LOGICAL-c361t-88b3c07ffecb6e82ec09c86b14abf897472d0d547f707698d5a656cd9b4177363</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Beattie, Genna</creatorcontrib><creatorcontrib>Cohan, Caitlin M.</creatorcontrib><creatorcontrib>Tang, Annie</creatorcontrib><creatorcontrib>Yasumoto, Eric</creatorcontrib><creatorcontrib>Victorino, Gregory P.</creatorcontrib><title>Differences in clinical characteristics and outcomes for blunt versus penetrating traumatic pulmonary pseudocysts</title><title>The American journal of emergency medicine</title><description>Traumatic pulmonary pseudocysts (TPPs) are under-reported in blunt trauma and rarely reported in penetrating trauma. Little is known about the impact of injury mechanism on the pathophysiology or the risk factors that predispose to worse patient outcomes. We hypothesized that blunt and penetrating TPPs have different clinical characteristics and outcomes.
Computed tomography imaging was evaluated for patients presenting at a level 1 trauma center with confirmed TPP from 2011 to 2018. Diameter was determined by largest dimension of the dominant TPP. Clinical variables and TPP features were compared for blunt versus penetrating trauma by using comparative statistics and multivariable analysis.e
A total of 101 TPP patients were identified (blunt = 64; penetrating = 37). In penetrating TPP, rates of concomitant pulmonary laceration, hemothorax, and pneumothorax, were, respectively, 4.5, 3.1, and 1.4 times higher than for blunt TPP. Concomitant rib fracture was twice as common in blunt TPP as in penetrating TPP (69% versus 32%). For penetrating injury, the risk of complications related to TPP was increased (aOR = 5.3), specifically persistent/recurrent pneumothorax (aOR = 10.4). All deaths resulted from pulmonary hemorrhage (blunt = 3, penetrating = 2). Regardless of mechanism, air-fluid level and hemoptysis correlated with death (p < 0.02) and all patients with hemoptysis required pulmonary intervention (p = 0.0001).
Penetrating TPPs demonstrate a unique pattern of concurrent lung injury and increased complication risk. Importantly, severe hemoptysis and air-fluid level may indicate risk of impending morbidity and mortality regardless of injury mechanism and should serve as an early warning sign for the trauma physician.</description><subject>Computed tomography</subject><subject>Contusions</subject><subject>Cysts</subject><subject>Emergency medical care</subject><subject>Hemoptysis</subject><subject>Hemorrhage</subject><subject>Hemothorax</subject><subject>Infections</subject><subject>Injuries</subject><subject>Intervention</subject><subject>Intubation</subject><subject>Lungs</subject><subject>Morbidity</subject><subject>Ostomy</subject><subject>Patients</subject><subject>Pneumothorax</subject><subject>Risk factors</subject><subject>Statistical analysis</subject><subject>Thoracic trauma</subject><subject>Trauma</subject><subject>Traumatic pneumatocele</subject><subject>Traumatic pulmonary pseudocyst</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kUtv1TAQhS0EEpfSP9CVJTZsEuzEj0RigwoUpEpsYG05kwk4SuzUj0r99_jqsmLRzcwsvjOaM4eQG85azrj6sLZ2xb3tWMdaNrZMDC_Iicu-awau-UtyYrqXjdJSvyZvUloZ41xIcSIPn92yYEQPmKjzFDbnHdiNwh8bLWSMLmUHiVo_01AyhL2CS4h02orP9BFjKoke6DFHm53_TWsvex2BHmXbg7fxiR4JyxzgKeX0lrxa7Jbw-l-_Ir--fvl5-625_3H3_fbTfQO94rkZhqkHputxMCkcOgQ2wqAmLuy0DKMWupvZLIVeNNNqHGZplVQwj5PgWveqvyLvL3uPGB4Kpmx2lwC3zXoMJZlOiHFUTHJR0Xf_oWso0dfrTCclU7wWXanuQkEMKUVczBHdXt0Zzsw5BbOacwrmnIJho6kpVNHHiwir1UeH0SRw52_PLiJkMwf3nPwvW2yS2w</recordid><startdate>202107</startdate><enddate>202107</enddate><creator>Beattie, Genna</creator><creator>Cohan, Caitlin M.</creator><creator>Tang, Annie</creator><creator>Yasumoto, Eric</creator><creator>Victorino, Gregory P.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202107</creationdate><title>Differences in clinical characteristics and outcomes for blunt versus penetrating traumatic pulmonary pseudocysts</title><author>Beattie, Genna ; Cohan, Caitlin M. ; Tang, Annie ; Yasumoto, Eric ; Victorino, Gregory P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c361t-88b3c07ffecb6e82ec09c86b14abf897472d0d547f707698d5a656cd9b4177363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Computed tomography</topic><topic>Contusions</topic><topic>Cysts</topic><topic>Emergency medical care</topic><topic>Hemoptysis</topic><topic>Hemorrhage</topic><topic>Hemothorax</topic><topic>Infections</topic><topic>Injuries</topic><topic>Intervention</topic><topic>Intubation</topic><topic>Lungs</topic><topic>Morbidity</topic><topic>Ostomy</topic><topic>Patients</topic><topic>Pneumothorax</topic><topic>Risk factors</topic><topic>Statistical analysis</topic><topic>Thoracic trauma</topic><topic>Trauma</topic><topic>Traumatic pneumatocele</topic><topic>Traumatic pulmonary pseudocyst</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Beattie, Genna</creatorcontrib><creatorcontrib>Cohan, Caitlin M.</creatorcontrib><creatorcontrib>Tang, Annie</creatorcontrib><creatorcontrib>Yasumoto, Eric</creatorcontrib><creatorcontrib>Victorino, Gregory P.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>ProQuest - Health & Medical Complete保健、医学与药学数据库</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Beattie, Genna</au><au>Cohan, Caitlin M.</au><au>Tang, Annie</au><au>Yasumoto, Eric</au><au>Victorino, Gregory P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Differences in clinical characteristics and outcomes for blunt versus penetrating traumatic pulmonary pseudocysts</atitle><jtitle>The American journal of emergency medicine</jtitle><date>2021-07</date><risdate>2021</risdate><volume>45</volume><spage>433</spage><epage>438</epage><pages>433-438</pages><issn>0735-6757</issn><eissn>1532-8171</eissn><abstract>Traumatic pulmonary pseudocysts (TPPs) are under-reported in blunt trauma and rarely reported in penetrating trauma. Little is known about the impact of injury mechanism on the pathophysiology or the risk factors that predispose to worse patient outcomes. We hypothesized that blunt and penetrating TPPs have different clinical characteristics and outcomes.
Computed tomography imaging was evaluated for patients presenting at a level 1 trauma center with confirmed TPP from 2011 to 2018. Diameter was determined by largest dimension of the dominant TPP. Clinical variables and TPP features were compared for blunt versus penetrating trauma by using comparative statistics and multivariable analysis.e
A total of 101 TPP patients were identified (blunt = 64; penetrating = 37). In penetrating TPP, rates of concomitant pulmonary laceration, hemothorax, and pneumothorax, were, respectively, 4.5, 3.1, and 1.4 times higher than for blunt TPP. Concomitant rib fracture was twice as common in blunt TPP as in penetrating TPP (69% versus 32%). For penetrating injury, the risk of complications related to TPP was increased (aOR = 5.3), specifically persistent/recurrent pneumothorax (aOR = 10.4). All deaths resulted from pulmonary hemorrhage (blunt = 3, penetrating = 2). Regardless of mechanism, air-fluid level and hemoptysis correlated with death (p < 0.02) and all patients with hemoptysis required pulmonary intervention (p = 0.0001).
Penetrating TPPs demonstrate a unique pattern of concurrent lung injury and increased complication risk. Importantly, severe hemoptysis and air-fluid level may indicate risk of impending morbidity and mortality regardless of injury mechanism and should serve as an early warning sign for the trauma physician.</abstract><cop>Philadelphia</cop><pub>Elsevier Inc</pub><doi>10.1016/j.ajem.2020.09.048</doi><tpages>6</tpages></addata></record> |
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| ispartof | The American journal of emergency medicine, 2021-07, Vol.45, p.433-438 |
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| source | ScienceDirect Freedom Collection 2022-2024 |
| subjects | Computed tomography Contusions Cysts Emergency medical care Hemoptysis Hemorrhage Hemothorax Infections Injuries Intervention Intubation Lungs Morbidity Ostomy Patients Pneumothorax Risk factors Statistical analysis Thoracic trauma Trauma Traumatic pneumatocele Traumatic pulmonary pseudocyst |
| title | Differences in clinical characteristics and outcomes for blunt versus penetrating traumatic pulmonary pseudocysts |
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