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Published on: April 7, 2021
Pediatric Acute Respiratory Distress Syndrome (PARDS) in Children With Pulmonary Contusion
Shivanand S Medar1,2,3, Sindy Villacres4, Shubhi Kaushik1,2
1Division of Pediatric Critical Care Medicine and Pediatric Cardiology, 37292Children's Hospital at Montefiore, Bronx, NY, USA.
Insights
Pediatric acute respiratory distress syndrome (PARDS) in children with pulmonary contusion (PC) is linked to lower Glasgow Coma Scale (GCS) scores and increased mortality. This highlights the severity of PC in pediatric trauma patients.
Area of Science:
- Pediatric critical care medicine
- Trauma surgery
- Respiratory medicine
Background:
- Limited data exists on the prevalence of pediatric acute respiratory distress syndrome (PARDS) in children experiencing pulmonary contusion (PC).
- Pulmonary contusion is a significant injury in pediatric chest trauma, but its association with PARDS requires further investigation.
Purpose of the Study:
- To evaluate the prevalence of pulmonary contusion (PC) in pediatric patients with chest trauma.
- To determine the association between pulmonary contusion (PC) and the development of pediatric acute respiratory distress syndrome (PARDS).
- To identify clinical factors associated with PARDS in children with PC.
Main Methods:
- Retrospective review of the Institutional Trauma Registry at a Level 1 trauma center.
- Inclusion criteria: Patients aged 18 years or younger with a diagnosis of pulmonary contusion (PC).
- Data collected included Glasgow Coma Scale (GCS) score, Injury Severity Scale (ISS) score, oxygenation parameters (FiO2, SpO2, S/F ratio), need for invasive mechanical ventilation (IMV), and mortality.
Main Results:
- Of 1916 children with trauma, 50 (2.6%) had PC. Patients with PC and PARDS exhibited significantly lower GCS scores, higher ISS scores, lower oxygen saturations, higher FiO2 requirements, and reduced S/F ratios compared to those without PARDS.
- The incidence of invasive mechanical ventilation (IMV) was substantially higher in the PC with PARDS group (86% vs. 23%), as was mortality (28% vs. 0%).
- Lower GCS score was independently associated with both PARDS and the need for IMV in children with PC.
Conclusions:
- Pediatric ARDS in children with pulmonary contusion is independently associated with lower GCS scores.
- The presence of PARDS in pediatric patients with PC significantly increases morbidity and mortality.
- Further large-scale studies are warranted to elucidate the relationship between lower GCS, higher injury scores, and PARDS in pediatric PC patients.
Objective:
There is paucity of data about prevalence of pediatric acute respiratory distress syndrome (PARDS) in children with pulmonary contusion (PC). We intend to evaluate PC in children with chest trauma and the association between PC and PARDS.
Design:
Retrospective review of Institutional Trauma Registry for patients with trauma.
Setting:
Level 1 trauma center.
Patients:
Age 18 years and younger with a diagnosis of PC.
Interventions:
None.
Measurements And Main Results:
Of the 1916 children with trauma, 50 (2.6%) had PC. Patients with PC and PARDS had lower Glasgow Coma Scale (GCS) score (7 [3-15] vs 15 [15-15], P = .0003), higher Injury Severity Scale (ISS) score (29 [22-34] vs 19 [14-22], P = .004), lower oxygen saturations (96 [93-99] days vs 99 [98-100] days, P = .0009), higher FiO2 (1 [1-1] vs 0.21 [0.21-0.40], P < .0001), lower oxygen saturation/FiO2 (S/F) ratios (97 [90-99] vs 457 [280-471], P < .0001), need for invasive mechanical ventilation (IMV; 86% vs 23%, P < .0001), and mortality (28% vs 0%, P = .006) compared to those without PARDS. Forty-two percent (21/50) of patients needed IMV, of these 61% (13/21) had PARDS. Patients who needed IMV had significantly lower GCS score (8 [3-11] vs 15 [15-15], P < .0001), higher ISS score (27 [22-34] vs 18 [14-22], P = .002), longer length of stay (LOS; 7.5 [4-14] days vs 3.3 [2-5] days, P = .003), longer hospital LOS (18 [7.0-25] vs 5 [4-11], P = .008), higher PARDS rate (62% vs 7%, P < .0001), and lower S/F ratios (99 [94-190] vs 461 [353-471], P < .0001) compared to those who did not require IMV. Lower GCS score was independently associated with both PARDS and need for IMV.
Conclusions:
Pediatric ARDS in children with PC is independently associated with lower GCS score, and its presence significantly increased morbidity and mortality. Further larger studies are needed to explore association of lower GCS and higher injury score in children with PARDS and PC.
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