Clinical Characteristics, Major Morbidity, and Mortality in Trauma-Related Pediatric Acute Respiratory Distress Syndrome

Abstract

Objectives: To determine the presence, central characteristics, and impact on major morbidity and mortality of trauma-related pediatric acute respiratory distress syndrome. Design: Retrospective review of a prospective trauma database. Setting: American College of Surgeons verified level 1 trauma center in an urban setting. Patients: Trauma patients age 0 to 18 years old inclusive. Interventions: None. Measurements and Main Results: Of the 7,382 patients presenting within the 10-year study period, 646 met study criteria for inclusion in the analysis. Trauma-related pediatric acute respiratory distress syndrome was present in 9% of the analyzed cohort. On univariate analysis and compared with those without, trauma-related pediatric acute respiratory distress syndrome occurred more commonly among those with traumatic brain injury (77.2% vs 45.5%; p < 0.001), non-accidental trauma (28.8% vs 10.2%; p < 0.001), and an injury severity score greater than 30 (27.1% vs 3.8%; p 0.001). New or progressive multiple organ dysfunction syndrome was significantly higher in trauma-related pediatric acute respiratory distress syndrome patients (86.7% vs 10.4%; p < 0.001) as was mortality (18.3% vs 3.1%; p < 0.001) than in those without. The presence of trauma-related pediatric acute respiratory distress syndrome (odds ratio, 6.98; 95% CI, 2.95-16.5; p < 0.001), younger age (odds ratio, 0.93; 95% CI, 0.87-0.99; p = 0.038), and worse injury severity (odds ratio, 1.19; 95% CI, 1.14-1.24; p < 0.001) were all independent statistical predictors of new or progressive multiple organ dysfunction syndrome in this retrospective cohort. Mortality in patients without trauma-related pediatric acute respiratory distress syndrome increased with increasing injury severity, whereas mortality in patients with trauma-related pediatric acute respiratory distress syndrome was the same regardless of injury severity. On multivariable regression analysis, while age and injury severity were independent statistical predictors of mortality, trauma-related pediatric acute respiratory distress syndrome was not (odds ratio, 2.35; 95% CI, 0.88-6.28; p = 0.087). Conclusions: Pediatric acute respiratory distress syndrome is present in the pediatric trauma population. Trauma-related pediatric acute respiratory distress syndrome is associated with eight times the organ dysfunction and five times the mortality compared with patients without trauma-related pediatric acute respiratory distress syndrome, yet research in this area is lacking. Further prospective, mechanistic evaluations are essential to understand why these patients are at risk and how to effectively intervene to improve outcomes.