Amory de Roulet1, Rita V Burke2, Joanna Lim3, Stephanie Papillon4, David W Bliss5, Henri R Ford6, Jeffrey S Upperman7, Kenji Inaba8, Aaron R Jensen9. 1. Keck School of Medicine of the University of Southern California; Division of General Surgery, New York-Presbyterian Queens, Flushing, NY 11355. Electronic address: Amd9075@nyp.org. 2. Division of Pediatric Surgery, Children's Hospital Los Angeles. Electronic address: riburke@chla.usc.edu. 3. Division of Pediatric Surgery, Children's Hospital Los Angeles. Electronic address: jlim@alamedahealthsystem.org. 4. Division of Pediatric Surgery, Children's Hospital Los Angeles. Electronic address: spapillon@huhosp.org. 5. Keck School of Medicine of the University of Southern California; Division of Pediatric Surgery, Children's Hospital Los Angeles. Electronic address: dbliss@chla.usc.edu. 6. Keck School of Medicine of the University of Southern California; Division of Pediatric Surgery, Children's Hospital Los Angeles. Electronic address: hford@chla.usc.edu. 7. Keck School of Medicine of the University of Southern California; Division of Pediatric Surgery, Children's Hospital Los Angeles. Electronic address: jupperman@chla.usc.edu. 8. Keck School of Medicine of the University of Southern California; Division of Acute Care Surgery and Surgical Critical Care, LAC+USC Medical Center Los Angeles, CA 90027. Electronic address: kenji.inaba@med.usc.edu. 9. 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.
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.
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 traumapatients, 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.
Authors: Elizabeth Y Killien; Roel L N Huijsmans; Iesha L Ticknor; Lincoln S Smith; Monica S Vavilala; Frederick P Rivara; R Scott Watson Journal: Crit Care Med Date: 2020-01 Impact factor: 7.598
Authors: Maria M Galardi; Jennifer M Strahle; Alex Skidmore; Akash P Kansagra; Kristin P Guilliams Journal: Pediatr Neurol Date: 2020-01-11 Impact factor: 3.372
Authors: Elizabeth Y Killien; Brianna Mills; R Scott Watson; Monica S Vavilala; Frederick P Rivara Journal: Crit Care Med Date: 2019-02 Impact factor: 7.598
Authors: Michael A Matthay; Rachel L Zemans; Guy A Zimmerman; Yaseen M Arabi; Jeremy R Beitler; Alain Mercat; Margaret Herridge; Adrienne G Randolph; Carolyn S Calfee Journal: Nat Rev Dis Primers Date: 2019-03-14 Impact factor: 52.329
Authors: Nicole P Juffermans; Cécile Aubron; Jacques Duranteau; Alexander P J Vlaar; Daryl J Kor; Jennifer A Muszynski; Philip C Spinella; Jean-Louis Vincent Journal: Intensive Care Med Date: 2020-11-12 Impact factor: 17.440