Institutional members access full text with Ovid®

Impact of Acute Lung Injury and Acute Respiratory Distress Syndrome After Traumatic Brain Injury in the United States

Rincon, Fred MD, MSc*,‡; Ghosh, Sayantani MBBS; Dey, Saugat MBBS; Maltenfort, Mitchell PhD§; Vibbert, Matthew MD*,‡; Urtecho, Jacqueline MD*,‡; McBride, William MD*,¶; Moussouttas, Michael MD*,¶; Bell, Rodney MD*,‡,¶; Ratliff, John K. MD||; Jallo, Jack MD, PhD

doi: 10.1227/NEU.0b013e3182672ae5
Research-Human-Clinical Studies
Press Release

BACKGROUND: Traumatic brain injury (TBI) is a major cause of disability, morbidity, and mortality. The effect of the acute respiratory distress syndrome and acute lung injury (ARDS/ALI) on in-hospital mortality after TBI remains controversial.

OBJECTIVE: To determine the epidemiology of ARDS/ALI, the prevalence of risk factors, and impact on in-hospital mortality after TBI in the United States.

METHODS: Retrospective cohort study of admissions of adult patients >18 years with a diagnosis of TBI and ARDS/ALI from 1988 to 2008 identified through the Nationwide Inpatient Sample.

RESULTS: During the 20-year study period, the prevalence of ARDS/ALI increased from 2% (95% confidence interval [CI], 2.1%–2.4%) in 1988 to 22% (95% CI, 21%–22%) in 2008 (P < .001). ARDS/ALI was more common in younger age; males; white race; later year of admission; in conjunction with comorbidities such as congestive heart failure, hypertension, chronic obstructive pulmonary disease, chronic renal and liver failure, sepsis, multiorgan dysfunction; and nonrural, medium/large hospitals, located in the Midwest, South, and West continental US location. Mortality after TBI decreased from 13% (95% CI, 12%–14%) in 1988 to 9% (95% CI, 9%–10%) in 2008 (P < .001). ARDS/ALI-related mortality after TBI decreased from 33% (95% CI, 33%–34%) in 1988 to 28% (95% CI, 28%–29%) in 2008 (P < .001). Predictors of in-hospital mortality after TBI were older age, male sex, white race, cancer, chronic kidney disease, hypertension, chronic liver disease, congestive heart failure, ARDS/ALI, and organ dysfunctions.

CONCLUSION: Our analysis demonstrates that ARDS/ALI is common after TBI. Despite an overall reduction of in-hospital mortality, ARDS/ALI carries a higher risk of in-hospital death after TBI.

ABBREVIATIONS: AECC, American-European Consensus Conference

ALI, acute lung injury

ARDS, acute respiratory distress syndrome

CXR, chest x-ray

GEE, generalized estimated equation

ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification

NIS, Nationwide Inpatient Sample

PAOP, pulmonary artery occlusion pressures

PPV, positive predictive value

TBI, traumatic brain injury

*Department of Neurology, Division of Critical Care, Thomas Jefferson University, Philadelphia, Pennsylvania

Department of Neurosurgery, Division of Neurotrauma, Thomas Jefferson University, Philadelphia, Pennsylvania

§Department of Biostatistics, The Rothman Institute, Philadelphia, Pennsylvania

Division of Cerebrovascular Diseases, Thomas Jefferson University, Philadelphia, Pennsylvania

||Department of Neurosurgery, Stanford University School of Medicine, Stanford, California

Correspondence: Fred Rincon, MD, MSc, FACP, FCCP, FAHA, Assistant Professor of Neurology and Neurological Surgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson College of Medicine, Division of Critical Care and Neurotrauma, 909 Walnut St, 3rd Floor, Philadelphia, PA 19107. E-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received March 23, 2012

Accepted June 26, 2012

Copyright © by the Congress of Neurological Surgeons