Association between age and acute respiratory distress syndrome development and mortality following trauma
| Autor: | Brianna Mills, Watson Rs, Monica S. Vavilala, Elizabeth Y Killien, F. P. Rivara, OʼKeefe Ge |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Risk ARDS medicine.medical_specialty Adolescent Databases Factual Acute respiratory distress Critical Care and Intensive Care Medicine Article Young Adult Injury Severity Score Risk Factors Humans Medicine Glasgow Coma Scale Young adult Child Intensive care medicine Aged Retrospective Studies Aged 80 and over Respiratory Distress Syndrome business.industry Age Factors Retrospective cohort study Middle Aged medicine.disease Pathophysiology Traumatic injury Child Preschool Wounds and Injuries Female Surgery business |
| Zdroj: | J Trauma Acute Care Surg |
| ISSN: | 2163-0763 2163-0755 |
| Popis: | Improved understanding of the relationship between patient age and acute respiratory distress syndrome (ARDS) development and mortality following traumatic injury may help facilitate generation of new hypotheses about ARDS pathophysiology and the role of novel treatments to improve outcomes across the age spectrum.We conducted a retrospective cohort study of trauma patients included in the National Trauma Data Bank who were admitted to an intensive care unit from 2007 to 2016. We determined ARDS incidence and mortality across eight age groups for the entire 10-year study period and by year. We used generalized linear Poisson regression models adjusted for underlying mortality risk (injury mechanism, Injury Severity Score, admission Glasgow Coma Scale score, admission heart rate, and admission hypotension).Acute respiratory distress syndrome occurred in 3.1% of 1,297,190 trauma encounters. Acute respiratory distress syndrome incidence was lowest among pediatric patients and highest among adults aged 35 to 64 years. Acute respiratory distress syndrome mortality was highest among patients 80 years or older (43.9%), followed by 65 to 79 years (30.6%) and 4 years or younger (25.3%). The relative risk of mortality associated with ARDS was highest among the pediatric age groups, with an adjusted relative risk (aRR) of 2.06 (95% confidence interval [CI], 1.72-2.70) among patients 4 years or younger compared with an aRR of 1.51 (95% CI, 1.42-1.62) for the entire cohort. Acute respiratory distress syndrome mortality increased over the 10-year study period (aRR, 1.03 per year; 95% CI, 1.02-1.05 per year), whereas all-cause mortality decreased (aRR, 0.98 per year; 95% CI, 0.98-0.99 per year).While ARDS development following traumatic injury was most common in middle-aged adults, patients 4 years or younger and 65 years or older with ARDS experienced the highest burden of mortality. Children 4 years or younger were disproportionately affected by ARDS relative to their low underlying mortality following trauma that was not complicated by ARDS. Acute respiratory distress syndrome-associated mortality following trauma has worsened over the past decade, emphasizing the need for new prevention and treatment strategies.Prognostic/epidemiological study, level III. |
| Databáze: | OpenAIRE |
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