Trauma indices for prediction of acute respiratory distress syndrome

Abstract

Background A myriad of trauma indices have been validated to predict probability of trauma survival. We aimed to compare the performance of commonly used indices for the development of the Acute Respiratory Distress Syndrome (ARDS). Materials and Methods Historic, observational cohort study of 27,385 consecutive patients admitted to a statewide referral trauma center between July 11, 2003 and October 31, 2011. A validated algorithm was adapted to identify patients with ARDS. Each trauma index was evaluated in logistic regression using the area under the receiver operating characteristic curve. Results The case-rate for ARDS development was 5.8% (1,594). The receiver operating characteristics for ISS had the best discrimination and had an area under the curve of 0.88 (95% CI 0.87–0.89). Glasgow coma score (0.71, 95% CI 0.70–0.73), A Severity Characterization of Trauma (0.86, 95% CI 0.85–0.87), Revised Trauma Score (0.71, 95% CI 0.70–0.72) and thorax Abbreviated Injury Score (0.73, 95% CI 0.72–0.74) performed worse (p<0.001) and Trauma and Injury Severity Score (0.88, 95% CI 0.87–0.88) performed equivocally (p=0.51) in comparison to ISS. Using a cutoff point ISS greater than or equal to 16, sensitivity and specificity were 84.9% (95% CI 83.0%–86.6%) and 75.6% (95% CI 75.1%–76.2%), respectively. Conclusions Among commonly used trauma indices, ISS has superior or equivocal discriminative ability for development of ARDS. A cutoff point of ISS greater than or equal to 16 provided good sensitivity and specificity. The use of ISS greater than or equal to 16 is a simple method to evaluate ARDS in trauma epidemiology and outcomes research.

Risk Factors on Hospital Arrival for Acute Respiratory Distress Syndrome Following Pediatric Trauma*

“…The 1.8% incidence of ARDS among pediatric ICU patients is lower than the ARDS incidence among adults with traumatic injuries. 3–5,7,10–11 This is consistent with previous findings that children have lower incidence of ARDS from all etiologies compared to adults. 13,26 While this may in part be due to differences in lung and chest wall development, pulmonary physiology, biomechanics, and mechanisms of injury, there may also be under-recognition of the problem.…”

Association between age and acute respiratory distress syndrome development and mortality following trauma

“…After adjusting for underlying risk of mortality, the adjusted RR for death associated with ARDS was 1.51 (95% CI 1.42-1.62). Median time to death was 8 days (IQR 3-15) among ARDS patients and 3 days (IQR 1-8) among patients without ARDS; time to death was shortest among patients ≤4 years for both ARDS (3 days, IQR 2-5) and non-ARDS cohorts (2 days, IQR 1-4) and longer with each advancing age group until age 65-79 (ARDS 10 days [4][5][6][7][8][9][10][11][12][13][14][15][16][17]; non-ARDS 4 days [2][3][4][5][6][7][8][9][10]).…”

“…Severe traumatic injury is a well-described trigger for ARDS, with 5-10% of adult trauma patients [1][2][3][4] and up to 19% of adult trauma patients requiring intensive care unit (ICU) care 5 developing ARDS. Most studies of injured adults with ARDS have found a mortality rate of 16-24%, 2,3,[6][7][8][9] with estimates as high as 35-45% in severely ill cohorts. 1,10 The epidemiology of ARDS in the pediatric trauma population is not well described; the only study to date found an incidence of 1.8% with 20.0% mortality.…”

Morbidity and Mortality Among Critically Injured Children With Acute Respiratory Distress Syndrome

“…A challenge in studying post-traumatic ARDS is to distinguish the effect of ARDS on outcomes from the impact of the severity of the injury itself. While most adult studies have found that unadjusted mortality is higher among patients with ARDS than those without, [15][16][17][18][19][20][21] several have found no additional impact of ARDS on mortality after adjusting for confounding factors such as age, injury severity, and physiologic parameters on admission. 15,16 We therefore aimed to evaluate outcomes among pediatric patients with post-traumatic ARDS by estimating risk for all-cause hospital mortality after adjusting for underlying mortality risk, and assessing markers of morbidity among survivors including hospital resource utilization and need for ongoing post-discharge care.…”