Age and Low Blood Pressure Predict Lung Complications After Blunt Chest Trauma

Older patients and those arriving with lower blood pressure are more likely to develop serious lung complications after blunt chest trauma, according to a retrospective cohort study conducted at a Thai hospital and published in BMC Surgery.

Researchers led by Chollakarn Varopas of Maharaj Nakhon Chiang Mai Hospital reviewed the records of adults aged 18 years or older who were admitted with blunt chest trauma between January 1, 2022, and December 31, 2024. The team set out to identify clinical factors that are readily available at the bedside and associated with pulmonary complications within 30 days of injury.

Blunt chest wall trauma is a major contributor to the global trauma burden and is linked with a high rate of delayed pulmonary complications, including pneumonia and respiratory failure. Previous research has pointed to risk factors such as advanced age, injury severity and the number of rib fractures, and several scoring systems have been developed to predict outcomes. However, the study’s authors note that some existing scoring systems may be of limited use in settings where detailed radiographic assessment is not routinely available, which motivated the search for simpler clinical predictors.

The researchers excluded patients with unsurvivable injuries classified as an Abbreviated Injury Scale score of 6, those who presented late with pre-existing complications, and patients who died in the emergency department. The primary outcome was the occurrence of pulmonary complications within 30 days. Secondary outcomes included hospital length of stay, intensive care unit length of stay, duration of mechanical ventilation and mortality.

In the multivariable analysis, increasing age was independently associated with pulmonary complications, with an adjusted odds ratio of 1.07 per year of age (95% confidence interval 1.03 to 1.11; p < 0.001). Lower initial systolic blood pressure was also independently associated with complications, with an adjusted odds ratio of 0.97 per mmHg (95% confidence interval 0.94 to 0.99; p = 0.014). Because these figures come from a single-centre retrospective cohort, they describe associations within this study population rather than proven causal effects, and the findings await validation in other settings.

The consequences of developing a pulmonary complication were substantial. Their intensive care unit stays were also longer, at 5 days versus 2 days, and they spent more time on mechanical ventilation, at 5 days versus 3 days. All of these differences reached the threshold of p < 0.01.

The study’s conclusion is straightforward: pulmonary complications are common after blunt chest trauma and are associated with worse clinical outcomes. Increasing age and lower initial systolic blood pressure were the two factors that remained independently associated with these complications in the analysis. Both measurements can be obtained quickly and without specialised imaging, which the authors argue makes them practical tools for early risk assessment.

The authors suggest that these readily available clinical factors may help clinicians identify patients who warrant closer monitoring after blunt chest injury. Because the analysis is retrospective and drawn from a single hospital, the authors frame the results as a step toward simpler risk stratification rather than a definitive prediction rule, and they note that the applicability of more complex existing scoring systems may be limited where detailed radiographic assessment is not routinely available.

For trauma teams, the message is that two of the most basic measurements taken at admission, a patient’s age and initial systolic blood pressure, carried independent predictive information about pulmonary outcomes in this cohort. The study was published as an open access article in BMC Surgery on October 27, 2026, and the published version notes that it is being shared early to provide faster access to peer-reviewed, accepted research, with a final version of record to follow.

Subject of Research: Clinical risk factors for pulmonary complications following blunt chest trauma

Article Title: Clinical factors associated with pulmonary complications after blunt chest trauma: a retrospective cohort study

Article References: Varopas, C., Khorana, J., Chandacham, K., Chotirosniramit, N., Chittawatanarat, K., Jirapongcharoenlap, T., & Homchan, O. U. (2026). Clinical factors associated with pulmonary complications after blunt chest trauma: a retrospective cohort study. BMC Surgery. https://doi.org/10.1186/s12893-026-04301-4

Image Credits: AI Generated

DOI: 10.1186/s12893-026-04301-4

Keywords: blunt chest trauma, pulmonary complications, rib fractures, pneumonia, respiratory failure, systolic blood pressure, retrospective cohort study, trauma outcomes, risk prediction, intensive care, mechanical ventilation, BMC Surgery