Medical planning for disaster response: Identifying risk factors for developing adult respiratory distress syndrome among trauma patients

Introduction: Adult respiratory distress syndrome (ARDS) is a well-described complication of critical illness. We hypothesized that rates of comorbid diseases in a population may influence the risk for developing ARDS in trauma patients. This can help plan medical responses.Methods: Patients from the 2017 National Trauma Databank were analyzed. Inclusion criteria were an injury severity score (ISS) of ≥ 2 and 1 or more documented days of mechanical ventilation. Data were analyzed using χ2, Student’s t test, Mann–Whitney U test, or logistic regression as indicated.Results: Diabetes (odds ratio [OR] 1.33, 95 percent confidence interval [CI] 1.17-1.52), smoking (OR 1.26, 95 percent CI 1.13-1.40), transfusion (OR 1.20, 95 percent CI 1.09-1.32), ISS (OR 1.02, 95 percent CI 1.02-1.03), male gender (OR 1.22, 95 percent CI 1.10-1.35), decreasing Glasgow coma score (OR 1.04, 95 percent CI 1.03-1.05), and increasing abbreviated injury score of the thorax (OR 1.12, 95 percent CI 1.09-1.16) were associated with an increase in risk for developing ARDS.Conclusion: Diabetes and smoking are risk factors for developing ARDS after trauma. Medical response planning in countries with high rates of diabetes mellitus or smoking should take into account a greater need for intensive care and longer patient admissions to field hospitals.

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Nationwide cohort study of independent risk factors for acute respiratory distress syndrome after trauma

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2018-000249 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000249 ◽

Cited By ~ 7

Author(s):

Christopher J Tignanelli ◽

Mark R Hemmila ◽

Mary A M Rogers ◽

Krishnan Raghavendran

Keyword(s):

Risk Factors ◽

Acute Respiratory Distress Syndrome ◽

Cohort Study ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Injury Severity ◽

Distress Syndrome ◽

Thoracic Injury ◽

Trauma Patients ◽

History Of

BackgroundThe primary objective of this study was to evaluate the effect of specific direct and indirect factors that accounted, in trauma patients, for the development of acute respiratory distress syndrome (ARDS) and mortality in patients with ARDS.MethodsWe performed a retrospective cohort study of patients from the National Trauma Data Bank. Multilevel mixed-effects logistic regression was used with the development of ARDS as the primary and mortality in patients with ARDS as the secondary outcome measures. We compared trauma patients with versus without thoracic (direct) and extrathoracic (indirect) risk factors, using patient demographics, physiologic, and anatomic injury severity as covariates. Subset analysis was performed for patients with trauma-induced lung contusion (TILC) and for patients with minor (Injury Severity Score [ISS] ≤15) injury.ResultsA total of 2 998 964 patients were studied, of whom 28 597 developed ARDS. From 2011 to 2014, the incidence of ARDS decreased; however, mortality in patients with ARDS has increased. Predictors of ARDS included direct thoracic injury (TILC, multiple rib fractures, and flail chest), as well as indirect factors (increased age, male gender, higher ISS, lower Glasgow Coma Scale motor component score, history of cardiopulmonary or hematologic disease, and history of alcoholism or obesity). Patients with ARDS secondary to direct thoracic injury had a lower risk of mortality compared with patients with ARDS due to other mechanisms.DiscussionDespite the decreasing incidence of trauma-induced ARDS, mortality in patients with ARDS has increased. Direct thoracic injury was the strongest predictor of ARDS. Knowing specific contributors to trauma-induced ARDS could help identify at-risk patients early in their hospitalization and mitigate the progression to ARDS and thereby mortality.Level of evidencePrognostic study, level III.

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