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Pediatric trauma-associated acute respiratory distress syndrome: Incidence, risk factors, and outcomes
Amory de Roulet1, Rita V Burke2, Joanna Lim2
1Keck School of Medicine of the University of Southern California; Division of General Surgery, New York-Presbyterian Queens, Flushing, NY 11355.
Insights
Pediatric trauma-associated Acute Respiratory Distress Syndrome (PT-ARDS) is rare but deadly, with 18.6% mortality. Early recognition and lung-protective measures are key to improving outcomes for injured children.
Area of Science:
- Pediatric critical care medicine
- Trauma surgery
- Respiratory medicine
Background:
- Acute Respiratory Distress Syndrome (ARDS) poses a significant threat to pediatric trauma patients.
- Understanding the specific risk factors and outcomes of PT-ARDS is crucial for improving patient care.
Purpose of the Study:
- To identify risk factors associated with pediatric trauma-associated ARDS (PT-ARDS).
- To determine the outcomes, including mortality, for children who develop PT-ARDS.
Main Methods:
- Retrospective cohort study utilizing the American College of Surgeons National Trauma Data Bank (NTDB) from 2007-2014.
- Analysis included children 18 years or younger.
- Identified incidence, risk factors, and outcomes related to PT-ARDS.
Main Results:
- PT-ARDS occurred in 0.5% of pediatric trauma patients, with an 18.6% mortality rate, often within the first week post-injury.
- Risk factors included nonaccidental trauma, near drowning, severe head/chest injury, pneumonia, sepsis, thoracotomy, laparotomy, transfusion, and TPN.
- PT-ARDS was independently associated with increased mortality (aOR 1.33).
Conclusions:
- Pediatric trauma-associated ARDS is an uncommon but severe complication with high early mortality.
- Prompt identification and early implementation of lung-protective strategies are essential for potentially altering outcomes in PT-ARDS.
Background/Purpose:
Acute Respiratory Distress Syndrome (ARDS) results in significant morbidity and mortality in pediatric trauma victims. The objective of this study was to determine risk factors and outcomes specifically related to pediatric trauma-associated ARDS (PT-ARDS).
Methods:
A retrospective cohort (2007-2014) of children ≤18 years old from the American College of Surgeons National Trauma Data Bank (NTDB) was used to analyze incidence, risk factors, and outcomes related to PT-ARDS.
Results:
PT-ARDS was identified in 0.5% (2660/488,381) of the analysis cohort, with an associated mortality of 18.6% (494/2660). Mortality in patients with PT-ARDS most commonly occurred in the first week after injury. Risk factors associated with the development of PTARDS included nonaccidental trauma, near drowning, severe injury (AIS ≥ 3) to the head or chest, pneumonia, sepsis, thoracotomy, laparotomy, transfusion, and total parenteral nutrition use. After adjustment for age, injury complexity, injury mechanism, and physiologic variables, PT-ARDS was found to be independently associated with higher mortality (adjusted OR 1.33, 95% CI 1.18-1.51, p < 0.001).
Conclusions:
PT-ARDS is a rare complication in pediatric trauma patients, but is associated with substantial mortality within 7 days of injury. Recognition and initiation of lung-protective measures early in the postinjury course may represent the best opportunity to change outcomes.
Level Of Evidence:
Level 3 - Epidemiologic.
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