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Acute Respiratory Distress Syndrome Following Pediatric Trauma

Application of Pediatric Acute Lung Injury Consensus Conference Criteria

Killien, Elizabeth Y. MD, MPH1,2; Huijsmans, Roel L. N.1,3; Ticknor, Iesha L.1,4; Smith, Lincoln S. MD2,5; Vavilala, Monica S. MD1,6; Rivara, Frederick P. MD, MPH1,7,8; Watson, R. Scott MD, MPH2,7

doi: 10.1097/CCM.0000000000004075
Online Clinical Investigation: PDF Only
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Objectives: To assess the incidence, severity, and outcomes of pediatric acute respiratory distress syndrome following trauma using Pediatric Acute Lung Injury Consensus Conference criteria.

Design: Retrospective cohort study.

Setting: Level 1 pediatric trauma center.

Patients: Trauma patients less than or equal to 17 years admitted to the ICU from 2009 to 2017.

Interventions: None.

Measurements and Main Results: We queried electronic health records to identify patients meeting pediatric acute respiratory distress syndrome oxygenation criteria for greater than or equal to 6 hours and determined whether patients met complete pediatric acute respiratory distress syndrome criteria via chart review. We estimated associations between pediatric acute respiratory distress syndrome and outcome using generalized linear Poisson regression adjusted for age, injury mechanism, Injury Severity Score, and serious brain and chest injuries. Of 2,470 critically injured children, 103 (4.2%) met pediatric acute respiratory distress syndrome criteria. Mortality was 34.0% among pediatric acute respiratory distress syndrome patients versus 1.7% among patients without pediatric acute respiratory distress syndrome (adjusted relative risk, 3.7; 95% CI, 2.0–6.9). Mortality was 50.0% for severe pediatric acute respiratory distress syndrome at onset, 33.3% for moderate, and 30.5% for mild. Cause of death was neurologic in 60.0% and multiple organ failure in 34.3% of pediatric acute respiratory distress syndrome nonsurvivors versus neurologic in 85.4% of nonsurvivors without pediatric acute respiratory distress syndrome (p = 0.001). Among survivors, 77.1% of pediatric acute respiratory distress syndrome patients had functional disability at discharge versus 30.7% of patients without pediatric acute respiratory distress syndrome patients (p < 0.001), and only 17.5% of pediatric acute respiratory distress syndrome patients discharged home without ongoing care versus 86.4% of patients without pediatric acute respiratory distress syndrome (adjusted relative risk, 1.5; 1.1–2.1).

Conclusions: Incidence and mortality associated with pediatric acute respiratory distress syndrome following traumatic injury are substantially higher than previously recognized, and pediatric acute respiratory distress syndrome development is associated with high risk of poor outcome even after adjustment for underlying injury type and severity.

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.

3University Medical Center Utrecht, Utrecht, The Netherlands.

4University of Washington, Seattle, WA.

5Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA.

6Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.

7Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA.

8Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, WA.

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

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 website (http://journals.lww.com/ccmjournal).

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 the National Institutes of Health (NIH). Drs. Killien, Vavilala, and Rivara received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: elizabeth.killien@seattlechildrens.org

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