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Published on: April 7, 2021
Incidence and Mortality of Acute Respiratory Distress Syndrome in Children: A Systematic Review and Meta-Analysis
Laura R A Schouten1, Floor Veltkamp, Albert P Bos
11Department of Pediatric Intensive Care, Academic Medical Center, Amsterdam, The Netherlands. 2Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands. 3Department of Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands. 4Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Insights
Pediatric acute respiratory distress syndrome (PARDS) has a low incidence but high mortality. Incidence and mortality rates for PARDS have remained unchanged over the past 20 years, with mortality varying by geographic location.
Area of Science:
- Pediatric critical care medicine
- Respiratory medicine
- Epidemiology
Background:
- Acute respiratory distress syndrome (ARDS) in children (pediatric ARDS or PARDS) is understudied compared to adult populations.
- Preclinical data suggest children may have different susceptibility and severity of PARDS than adults.
- Limited data exist on the epidemiological trends of PARDS.
Purpose of the Study:
- To assess the incidence and mortality of pediatric ARDS.
- To analyze trends in PARDS incidence and mortality over the last two decades.
- To identify factors influencing PARDS outcomes.
Main Methods:
- Systematic review and meta-analysis of studies published in Medline, Embase, and CINAHL up to August 2014.
- Inclusion of population-based or PICU-based studies reporting PARDS incidence and mortality in children (<18 years).
- Data extraction, quality assessment, and meta-regression analysis to explore heterogeneity.
Main Results:
- Twenty-nine studies reported incidence and 32 reported mortality.
- Pooled incidence of PARDS was 3.5 per 100,000 person-years (population-based) and 2.3% (PICU-based).
- Pooled mortality for PARDS was 33.7%. No significant trends in incidence or mortality were observed over time, but mortality varied by study location.
Conclusions:
- Pediatric ARDS has a low incidence but a high mortality rate.
- PARDS incidence and mortality have remained stable over the past two decades.
- Geographic location is a significant factor associated with PARDS mortality.
Objectives:
Our understanding of the acute respiratory distress syndrome in children is limited, and literature is dominated by investigations in adult patients. Recent preclinical studies suggest that the susceptibility to and severity of acute respiratory distress syndrome in children could differ from that in adults. We assessed the incidence and mortality of acute respiratory distress syndrome reported in children in studies published in the last two decades.
Data Sources:
Medline, Embase, and CINAHL databases were searched up to August 2014.
Study Selection:
Articles reporting study data on population- or PICU-based incidence and mortality of acute respiratory distress syndrome in children (> 36 wk gestation and < 18 yr old) were selected.
Data Extraction:
Two authors independently collected data and assessed methodological quality and risk of bias of selected studies. Pooled estimates of incidence and mortality were calculated using random-effects models. To explore heterogeneity, influence of study characteristics, including median year of conduct, study location, inclusion and exclusion criteria, and study design and quality, was assessed by meta-regression analysis.
Data Synthesis:
Twenty-nine studies reported on incidence and 32 on mortality. Pooled weighted estimate of the population-based and PICU-based incidence of pediatric acute respiratory distress syndrome was 3.5 (95% CI, 2.2-5.7) cases per 100,000 person years and 2.3% (95% CI, 1.9-2.9), respectively. Pooled weighted mortality was 33.7% (95% CI, 28.6-39.7). There were no trends over time, but mortality was significantly associated with study location.
Conclusions:
This systematic review and meta-analysis shows a low incidence but a high mortality. Its results also indicate that both incidence and mortality of pediatric acute respiratory distress syndrome have not changed over the last two decades and that mortality depends on the geographic location of studies.
