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Incidence of Adult Respiratory Distress Syndrome (ARDS) in trauma patients: A systematic review and meta-analysis over a period of three decades.

Pfeifer, Roman MD; Heussen, Nicole MSc, PhD; Michalewicz, Emilia; Hilgers, Ralf-Dieter PhD, Prof; Pape, Hans-Christoph MD, Prof.
Journal of Trauma and Acute Care Surgery: Post Acceptance: June 6, 2017
doi: 10.1097/TA.0000000000001571
Systematic Review: PDF Only

Background: In trauma patients, acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality. Changes in diagnostics, management and treatment may have influenced the incidence of ARDS. Therefore, the purpose of this manuscript is to evaluate whether there is a difference in the incidence of posttraumatic ARDS 1) over time, 2) attributable to geographic distribution, and 3) related to admitting surgical subspecialities.

Methods: A comprehensive search of articles published in English and German language was conducted using PubMed, MEDLINE, and the ISI Web of Science. Search terms included ARDS, acute respiratory distress syndrome, multiple trauma, polytrauma, and surgery. A meta-regression was performed to analyse differences between several decades of patient recruitment (decade 1: 1981-90; decade 2: 1991-2000; decade 3: 2001-2010), geographic location (North America and Europe), and the type of admitting surgical service (general vs orthopaedic trauma), respectively. Statistical analyses were performed with R (version 3.1.2, metafor package).

Results: The search included studies between 1.1.1980 and 31.12.2015 and revealed 43 trials from 40 publications (117.951 patients, 7.816 with post traumatic ARDS). The median incidences over the last three decades were similar between decade 1 (10.4%), decade 2 (7.7%), and decade 3 (8.0%), (p=0.8322). Geographical observations comparing central Europe and North Amercica revealed no statistically significant difference (Europe 13.0%) and North America (6.9%), (p=0.0696). The ARDS incidence in patients published based on a general surgery service (9.8%) was comparable to those published by orthopaedic trauma surgeons (7.0%) (p=0.3436).

Conclusion: The results of this meta-analysis discard the assumption that the following factors have influenced the incidence of postraumatic ARDS: There was neither a change in the incidence over the last decades, nor a geographical difference within western societies, nor associated with the admitting surgical subspeciality.

Level of Evidence: III

Study Type: Meta-analysis and systematic review

(C) 2017 Lippincott Williams & Wilkins, Inc.