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Pediatric trauma-associated acute respiratory distress syndrome: Incidence, risk factors, and outcomes.

Abstract：

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.

journal_name

J Pediatr Surg

journal_title

Journal of pediatric surgery

authors

de Roulet A,Burke RV,Lim J,Papillon S,Bliss DW,Ford HR,Upperman JS,Inaba K,Jensen AR

doi

10.1016/j.jpedsurg.2018.07.005

subject

Has Abstract

pub_date

2019-07-01 00:00:00

pages

1405-1410

issue

7

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(18)30434-2

journal_volume

54

pub_type

杂志文章

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