Risk Factors for ARDS in Hospitalized Burn Patients: An Analysis of the National Trauma Data Bank

Acute respiratory distress syndrome (ARDS) is a common complication among mechanically ventilated adult patients with burns; however, the risk factors associated with its development are not well understood. Conflicting evidence also exists regarding ARDS as an independent predictor of poor hospital outcomes. The purpose of this study is to identify risk factors for ARDS in mechanically ventilated adult patients with burns and characterize the impact of ARDS on hospital course. The National Trauma Data Bank was queried for patients ≥ 18 years with International Classification of Diseases (ICD) codes corresponding to burn injury from 2007 to 2016. Hospitalized patients with at least 48 h of mechanical ventilation were included. Multivariate logistic regression was used to identify risk factors for ARDS. Propensity score-matched analysis at a 1:3 ratio was used to determine the impact of ARDS on hospital course. This sample included 13,928 patients, of which 1437 (10.3%) developed ARDS. Hypotension in the emergency department, alcohol use disorder, total body surface area, injury severity score (ISS), and inhalation injury were independently associated with ARDS. In the propensity score-matched cohort, patients with ARDS had a significantly longer median (interquartile range) length of stay (31 [15-54] vs. 22 [9-43], P < .001). In-hospital mortality was also significantly higher in the ARDS cohort (203 [35%] vs. 325 [24%], P < .001). These findings highlight the impact of patient and injury characteristics on developing ARDS and support the consideration of ARDS when estimating mortality risk in patients with burns.