Early markers of acute respiratory distress syndrome development in severe trauma patients☆

Abstract 

Purpose

The aim of the study was to identify early risk factors for development of acute respiratory distress syndrome (ARDS) in severe trauma patients.

Materials and Methods

This was a prospective observational study of 693 severe trauma patients (Injury Severity Score ≥16 and/or Revised Trauma Score ≤11) in 17 hospitals in a Spanish region of 8 million inhabitants from July 2002 to December 2002.

Results

Acute respiratory distress syndrome developed in 6.9% of patients who were more severely ill with higher APACHE II (P < .001) and Injury Severity Score (P = .002) scores vs patients not developing ARDS. Acute respiratory distress syndrome development was associated (P < .001) with fractures of femur (International Classification of Diseases, Ninth Revision [ICD-9] codes 820, 821), tibia (ICD-9 code 823), humerus, and pelvis, with a number (≥2) of long bone fractures, and with chest injuries (rib/sternal fracture [ICD-9 code 807] and hemo/pneumothorax [ICD-9 code 860/861]). Patients with ARDS required more colloids (P = .005) and red blood cell units (P = .02) than patients without ARDS during the first 24 hours. Multivariate analysis showed that ARDS was related to chest trauma diagnosis (ICD-9 code 807) (odds ratio [OR], 3.85), femoral fracture (OR, 3.16), APACHE II score (OR, 1.05), and blood transfusion during resuscitation (OR, 1.32).

Conclusions

Risk of ARDS development is related to the first 24-hour admission variables, including severe physiologic derangements and specific ICD-9–classified injuries. Blood transfusion may play an independent role.

Keywords: Risk factors, MOF, Severe trauma, ARDS, Chest trauma, Blood transfusion