Citation

de Roulet A, Burke RV, Lim J, Papillon S, Bliss DW, Ford HR, Upperman JS, Inaba K, Jensen AR. J. Pediatr. Surg. 2019; 54(7): 1405-1410.

Affiliation

Keck School of Medicine of the University of Southern California; Division of Pediatric Surgery, Children's Hospital Los Angeles. Electronic address: ajensen@chla.usc.edu.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.jpedsurg.2018.07.005

PMID

30041860

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.

Copyright © 2018 Elsevier Inc. All rights reserved.

Language: en

Keywords

Acute respiratory distress syndrome; Critical care; Epidemiology; Outcomes; Pediatric; Trauma