Wikipedia:Featured article candidates/Pulmonary contusion


 * The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was promoted by User:SandyGeorgia 03:13, 22 July 2008.

Pulmonary contusion

 * Nominator(s): delldot   talk  

Pulmonary contusion is the most common potentially lethal chest injury. This article's had a peer review as well as several reviews on the talk page. In addition, three chest trauma experts have read it and said it's good or made minor suggestions that I've addressed. I believe it meets the FA criteria, but please let me know how it can be improved! delldot  talk  17:48, 16 July 2008 (UTC)

I first became involved with this article when delldot submitted it for "Good Article" nomination. Delldot has brought it to an exceptionally high standard, on a par with other medical featured articles. The content is accurate and the references are of good quality. I am happy to assist delldot with any further comments or suggestions. Axl (talk) 17:57, 16 July 2008 (UTC)

Issues resolved. — Wackymacs ( talk  ~  edits ) 20:10, 16 July 2008 (UTC) Comment - This is a good start, but this is overlinked. Here's some words which are linked, but should not be: "bruising", "shotgun", "World War I" and "World War II", "consolidate", "sensitive" and quite a few others. Please keep links minimal and relevant. Words like bruising and shotgun should not be linked because we know what they mean, and World War I and II we know about, and it doesn't have direct relation to Pulmonary contusion. — Wackymacs ( talk  ~  edits ) 18:38, 16 July 2008 (UTC)
 * Fair points, thanks. Although in this context, "sensitive" refers to the statistical meaning. Axl (talk) 18:44, 16 July 2008 (UTC)
 * Yes, thanks for pointing this out. I've removed the ones you mentioned and others I found when looking over the article (e.g. "ribcage"). I left the link to Consolidation (medicine), because I don't think it's a familiar concept to lay readers. delldot   talk  19:13, 16 July 2008 (UTC)

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 * Support - Very well written and fully referenced, meets the criteria nicely. These are both hard to do when the subject is as technical and difficult as this one. Well done! — Wackymacs ( talk  ~  edits ) 21:20, 16 July 2008 (UTC)


 * Comment - This is a little point. The use of a dash just after a footnote is regarded unfavorably. &mdash; Mattisse  (Talk) 19:03, 16 July 2008 (UTC)
 * Simply replaced the second dash with a comma, is this ok? delldot   talk  19:22, 16 July 2008 (UTC)
 * Yes. &mdash; Mattisse (Talk) 19:57, 16 July 2008 (UTC)
 * You had it right initially, Delldot, and this change resulted in incorrect punctuation, so I restored your original, correct punctuation. See WP:FN: "Footnotes at the end of a sentence or phrase are normally placed immediately after the punctuation, except for dashes, as recommended by the Chicago Manual of Style and other style guides."  This application is common.  Sandy Georgia  (Talk) 21:17, 16 July 2008 (UTC)
 * I was just going by what Tony1 said on a recent article that it was clumsy. I guess editors differ. &mdash; Mattisse (Talk) 21:22, 16 July 2008 (UTC)
 * Yes, in that article it was clumsy because there was a lot going on in the sentence; in this case, it's fine. Sandy Georgia  (Talk) 21:32, 16 July 2008 (UTC)
 * I guess it's no big deal either way, but would this make everyone happy? "The severity can range from mild to deadly: small contusions may have little or no impact on the patient's outcome,[3] yet pulmonary contusion is the most common type of potentially lethal chest trauma.[4]" delldot   talk  21:34, 16 July 2008 (UTC)
 * That works, too. The problem before was that the change left the clause opening with a dash but closing with a comma, which isn't correct.  There's nothing wrong with the way it is now.  Sandy Georgia  (Talk) 21:40, 16 July 2008 (UTC)
 * (ec) Yes. I agree with Tony's point. Thanks. &mdash; Mattisse  (Talk) 21:44, 16 July 2008 (UTC)

Resolved comments from Juliancolton Tropical Cyclone  19:26, 16 July 2008 (UTC)
 * Comments (ec) Regarding MoS compliance:
 * Per above, be sure not to overlink. Some words not mentioned yet include explosions, seat belts, and airbags is linked twice.
 * I think I've addressed this, let me know if you think I've gone too far or not far enough! delldot   talk  19:22, 16 July 2008 (UTC)


 * In the "X-ray" section, images shouldn't be left-aligned under section headers.
 * Done delldot   talk  19:22, 16 July 2008 (UTC)


 * It takes an average of six hours for the characteristic white regions to show up on a chest X-ray, and the contusion may not become apparent for 48 hours.[29][43][14] Keep the block of references in numerical order from lowest to highest.
 * Done delldot   talk  19:22, 16 July 2008 (UTC)


 * Chest injuries may also contribute to hypoventilation (inadequate breathing) because the chest wall movement involved in breathing adequately is painful.[59][58] Ditto.
 * Done delldot   talk  19:22, 16 July 2008 (UTC)


 * The severity can range from mild to deadly—small contusions may have little or no impact on the patient's outcome[3]&mdash;yet pulmonary contusion is the most common type of potentially lethal chest trauma. Try not to use dashes following a reference.
 * Done, if this fix is OK. delldot   talk  19:22, 16 July 2008 (UTC)


 * Otherwise looks good at a glance. Juliancolton Tropical Cyclone  19:09, 16 July 2008 (UTC)
 * Thanks much for the comments, I'll be glad to hear them if you have any more!  delldot   talk  19:22, 16 July 2008 (UTC)}}


 * Comment - "These two signs, as well as wheezing, may be present for 24 hours." Do you mean just for 24 hours? Somehow, this doesn't quite make sense to me. &mdash; Mattisse  (Talk) 20:17, 16 July 2008 (UTC)
 * Good point, why couldn't the symptoms be present after 24 hours? The source  says "Auscultation of breath sounds may reveal decreased breath sounds, rales, and wheezing over the next 24 hours", but the 24 hours thing isn't that vital so I'll take it out.   delldot   talk  21:10, 16 July 2008 (UTC)


 * Comment what is a "frank tear" (in the intro)? Please link to an appropriate wiktionary or wikipedia article for non-experts. Mangostar (talk) 20:43, 16 July 2008 (UTC)
 * A frank tear is a macroscopic one, as opposed to the many tiny tears to capillaries you'd find in a contusion. Changed to "cut or tear", I can add "macroscopic" or "visible to the naked eye" if it needs further clarification.   delldot   talk  21:18, 16 July 2008 (UTC)


 * Support. Difficult content very clearly explained to the best attainable level. Tightly supported with references. Only one question: do we still want to mention Swan-Ganz catheters (refs 13 & 55) now that there is strong evidence from various studies that these do more harm than good (see )? JFW | T@lk  21:07, 16 July 2008 (UTC)
 * I don't mind taking this out if you think we should. Are you sure you linked the right article?  I can't get it, but I don't see anything in the abstract about catheters.  The review  (ref 13) is from '07, so it's doubtful that more recent info has come up to change the practice (e.g. this is from '03). Anyway, I'm happy to take those sentences out if you think it's best.  delldot   talk  22:13, 16 July 2008 (UTC)
 * JFW, your pubmed reference: "One-view versus two-view mammography in baseline screening for breast cancer: a review". Perhaps you entered the wrong number? Of course JFW is right to remind us of the pulmonary artery catheter controversy, particularly with the arrival of LiDCO. Part of the problem was that PA catheters were being inserted into everyone arriving in ITU, whether they needed it or not. Most intensivists would still regard PA catheters as useful in very selected cases. For this article, I think that it is acceptable to include those two sentences that mention the PA catheter for patients who "require large amounts of fluid". Axl (talk) 07:38, 17 July 2008 (UTC)


 * Support. I agree with the above evaluation. I have been fascinated by the article. &mdash; Mattisse  (Talk) 21:24, 16 July 2008 (UTC)


 * Comment - This is a small complaint. You have intubation linked three times in the article, under slightly different wording. I personally don't mind, but if there is a concern with overlinking you may want to look at that. Also, I'm curious if viral pneumonia is a concern in hospitals. Another question, I notice that you mention pain under treatment. Is pain ever used as a sign or symptom in the beginning? &mdash; Mattisse  (Talk) 22:17, 16 July 2008 (UTC)
 * Thanks for catching the overlinking, I gotta watch out for that! I've never seen anything about viral pneumonia in any of the sources I've read, it's all been about how contusion creates an environment that's favorable for bacterial growth.  Pain would be due to associated chest wall injuries rather than contusion itself (at least I've never seen anything saying the contusion itself is painful). I've clarified this under Signs and symptoms.   delldot   talk  22:30, 16 July 2008 (UTC)
 * "I'm curious if viral pneumonia is a concern in hospitals." I presume that this is in the context of pulmonary contusion? The short answer is: no. The majority of cases of viral pneumonia are self-limiting. Many cases are due to influenza, RSV and adenovirus. Immunosuppressed patients are at risk of life-threatening viral pneumonia including HSV, CMV and chickenpox. However this is not relevant to "Pulmonary contusion". Axl (talk) 16:26, 17 July 2008 (UTC)


 * Comment Needs more copyediting. In an encyclopedia article, substitution of terms for the sake of variety probably should be avoided.  It causes confusion and, if the terms cannot be expected to be familiar to the reader, requires overlinking.  Eg: contusion, bruise, injury, lesion, etc.  If you mean exactly the same thing, it is okay (even preferable) to use exactly the same word. --Una Smith (talk) 06:21, 17 July 2008 (UTC)
 * Yes, good point, thanks. I've replaced all instances of 'lung contusion' and 'lesion' in the body with 'pulmonary contusion'.  Where 'the injury' was used to mean 'pulmonary contusion', I've replaced it; I left 'injury' where it referred to the causative event or more general conditions (e.g. 'lung injury', 'chest injury').  So hopefully it's more precise now.  delldot   talk  15:51, 17 July 2008 (UTC)
 * Better, but still needs more copyediting. Look at the lead paragraphs:  there are misplaced sentences in most of them.  It might help to give each paragraph a topic, maybe in hidden text:  mechanism, treatment, complications, etc. --Una Smith (talk) 15:50, 20 July 2008 (UTC)
 * Good suggestion. I reorganized the lead and gave each paragraph a hidden title: "Definition", "Causes & history", "Diagnosis & treatment", "Prognosis & epidemiology".  What do you think?  delldot   talk  16:08, 20 July 2008 (UTC)


 * Comments regarding images:
 * Image:AARDS X-ray cropped.jpg based on Image:ARDS X-Ray.jpg states "Chest X-ray of a patient with ARDS. Signed release into public domain, and licensed under GFDL as such". I'm going to ping Stevenfruitsmaak since he wrote the patient images essay to see what he thinks. Since there is nothing identifiable about the patient I would think there isn't an issue, but I'm not certain so I want to see if he has any feelings.
 * As far as I know, there is no clear consensus on the copyright status or the medical ethics of these images. Personally, I think Samir can be trusted with this statement (although I'm a bit confused by his PD - GFDL statement). As you say, identifiability is of primary concern. Currently, I don't see any reasons why this image would prevent FA status. Steven Fruitsmaak (Reply) 16:02, 17 July 2008 (UTC)
 * Image:Giambattista morgagni.gif, is missing an info tag could you please add a Commons:Template:Painting to specify as much information as possible, but especially source and date. -Optigan13 (talk) 06:33, 17 July 2008 (UTC)
 * I wasn't able to find the author or date for the image, so I replaced it with Image:Morgagni portrait.jpg. I still don't know the artist's name, but it was published in Morgagni's 1761 book. As I understand it, the author info isn't essential as long as it's known to be in the public domain because of its age, am I wrong?   delldot   talk  15:26, 17 July 2008 (UTC)
 * I would think it's ok as long as you know that it was published in a 1761 book and that it was retrieved from the linked Italian site is enough to safely assert that the image is in the public domain and from a verifiable source. In general though I think that is everything as far as images goes that covers it. Nice work on the fluid-filled alveoulus by the way, and thanks to Stephen. That does it for me Support -Optigan13 (talk) 04:55, 18 July 2008 (UTC)


 * Support — This is a little biased as I have done a little work on the article too but I think it's an excellent piece of work from all editors involved! — CycloneNimrod Talk? 21:09, 17 July 2008 (UTC)

Comments - sources look good. Links all checked out with the link checker tool. Ealdgyth - Talk 13:31, 18 July 2008 (UTC)

Comment I don't see any interwiki links, is that normal? Randomblue (talk) 15:06, 18 July 2008 (UTC) Comment - In one paragraph you have "compliance" wikilinked twice. Once it goes to Pulmonary compliance and the other to Compliance (physiology). Each article is tagged to be merged with the other. Perhaps it would be better to choose one wikilink and do away with the other. &mdash; Mattisse (Talk) 16:29, 20 July 2008 (UTC)
 * I think it's too obscure of a topic to have an article in any other languages, unfortunately. For example, it doesn't exist on es. Until April, it didn't have one here either. Of course, I'm not sure how I'd verify that for every language, but I think it's a safe bet that this is the only article on pulmonary contusion in any of the Wikipedias.   delldot   talk  15:19, 18 July 2008 (UTC)
 * That said, i'm sure the offer is there for anyone who is willing to translate the article for other projects ;) — CycloneNimrod Talk? 23:37, 18 July 2008 (UTC)
 * Makes sense, I'll go for pulmonary compliance in case it gets expanded, it should cover the more general compliance concept in that article whether or not they get merged. delldot   talk  16:37, 20 July 2008 (UTC)
 * Also, you discuss "consolidation" in two places: under the heading Consolidation and collapse and then you expand further on the explanation under X-ray. I suggest putting the complete explanation in one place for the sake of lay readers like me. &mdash; Mattisse (Talk) 16:42, 20 July 2008 (UTC)
 * Good catch. Moved the general sentence on consolidation in X-ray to Consolidation and collapse, but kept the X-ray appearance in X-ray because it wouldn't really fit anywhere else.   delldot   talk  17:18, 20 July 2008 (UTC)

Comment - Still having trouble with terminology, especially the distinctions under Classification. I notice that collapsed lung, if it were wikilinked, would link to pneumothorax. However, you have "A collapsed lung can result when the pleural cavity (the space outside the lung) accumulates blood (hemothorax) or air (pneumothorax) or both (hemopneumothorax)." I am confused whether "an injury to the lung tissue" is the same as a "lung injury" and therefore a "collapsed lung" would qualify. However, you say "Pulmonary laceration" is not the same. That must be because there is no "injury to the lung tissue"? I am not clear, still, on how pulmonary contusion differs from these other conditions. &mdash; Mattisse (Talk) 18:57, 20 July 2008 (UTC)
 * That's exactly right about pneumothorax etc. Reorganized the section, is it clearer now?  I emphasized that pneumothorax etc are not lung injuries per se (I believe they're classed as pleural injuries).  Let me know if it needs further work.   delldot   talk  19:18, 20 July 2008 (UTC)
 * Just one more question. You say, "An indication of more severe damage to the lung than contusion, a hematoma also takes longer to clear." This seems to minimize a contusion, but in the intro above that you have said, "yet pulmonary contusion is the most common type of potentially lethal chest trauma." Am I confused? &mdash; Mattisse (Talk) 20:53, 20 July 2008 (UTC)
 * No, I don't think it's a contradiction. Pulmonary contusion is more common than laceration (which can cause hematoma), but less severe.  They're both potentially lethal, though.  I was actually thinking of moving the sentence you quoted to pulmonary hematoma though, what do you think?   delldot   talk  21:08, 20 July 2008 (UTC)
 * That might be a good idea as it deflects from the main topic. &mdash; Mattisse  (Talk) 21:28, 20 July 2008 (UTC)
 * Done. Yeah, I was thinking it was a bit of a tangent anyway.   delldot   talk  21:36, 20 July 2008 (UTC)


 * Is there any particular reason why sometimes you use "pulmonary contusion" and sometime you use "bruising"? From my point of view as a lay person, you can't use "pulmonary contusion" too much as then I know exactly what you mean! I am assuming that "pulmonary contusion" and "contusion" are the same thing in this context.  &mdash; Mattisse  (Talk) 22:20, 21 July 2008 (UTC)
 * Whoops, thanks for catching that, I meant to replace all of these when Una Smith brought it up above, guess I missed a few. I've replaced the instances of 'bruising' now.  Is it OK that I've left 'contusion' instead of 'pulmonary contusion' in cases where it's clear from context that we're talking about lung tissue?  It's just that so many instances of 'pulmonary contusion' is wicked repetitive.   delldot   talk  22:28, 21 July 2008 (UTC)
 * I think contusion is clear (I know about the worries of repetition!) because you never use it in any other sense in this article. &mdash; Mattisse  (Talk) 23:08, 21 July 2008 (UTC)
 * The above discussion is preserved as an archive. Please do not modify it. No further edits should be made to this page.