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Risk Factors on Hospital Arrival for Acute Respiratory Distress Syndrome Following Pediatric Trauma*

Killien, Elizabeth Y., MD1,2; Mills, Brianna, PhD1; Watson, R. Scott, MD, MPH2,3; Vavilala, Monica S., MD1,4; Rivara, Frederick P., MD, MPH1,3,5

doi: 10.1097/CCM.0000000000003379
Online Clinical Investigations

Objectives: To determine risk factors identifiable at hospital arrival associated with acute respiratory distress syndrome development among critically injured children.

Design: Retrospective cohort study.

Setting: Level I or II adult or pediatric trauma centers contributing to the National Trauma Data Bank from 2007 to 2016.

Patients: Patients less than 18 years admitted to an ICU with traumatic injury.

Interventions: None.

Measurements and Main Results: We determined associations between patient, injury, and clinical characteristics present at hospital arrival with development of acute respiratory distress syndrome recorded as a hospital complication. Acute respiratory distress syndrome occurred in 1.8% of 146,058 critically injured children (n = 2,590). The only demographic factor associated with higher risk of developing acute respiratory distress syndrome on multivariable analysis was African American race (relative risk, 1.42 vs white; 95% CI, 1.13–1.78). Injury characteristics included firearm injuries (relative risk 1.93; 1.50–2.48) and motor vehicle crashes (relative risk, 1.91; 1.57–2.31) relative to falls; spine (relative risk, 1.39; 1.20–1.60), chest (relative risk, 1.36; 1.22–1.52), or lower extremity injuries (relative risk, 1.26; 1.10–1.44); amputations (relative risk, 2.10; 1.51–2.91); and more severe injury (relative risk, 3.69 for Injury Severity Score 40–75 vs 1–8; 2.50–5.44). Clinical variables included abnormal respiratory status (intubated relative risk, 1.67; 1.23–2.26 and hypopnea relative risk, 1.23; 1.05–1.45 and tachypnea relative risk, 1.26; 1.10–1.44) and lower Glasgow Coma Scale score (relative risk, 5.61 for Glasgow Coma Scale score 3 vs 15; 4.44–7.07).

Conclusions: We provide the first description of the incidence of and risk factors for acute respiratory distress syndrome among pediatric trauma patients. Improved understanding of the risk factors associated with acute respiratory distress syndrome following pediatric trauma may help providers anticipate its development and intervene early to improve outcomes for severely injured children.

1Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA.

2Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.

3Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA.

4Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.

5Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, WA.

*See also p. 2062.

This work was performed at Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA.

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Supported, in part, by National Institute of Child Health and Human Development grant 5 T32 HD057822-08.

Drs. Killien’s and Rivara’s institutions received funding from National Institute of Child Health and Human Development. Drs. Killien, Vavilala, and Rivara received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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