Acute Respiratory Distress Syndrome (ARDS) after trauma: Improving incidence, but increasing mortality

Purpose: Acute Respiratory Distress Syndrome (ARDS) is an infrequent, yet morbid inflammatory complication in injury victims. With the current project we sought to estimate trends in incidence, determine outcomes, and identify risk factors for ARDS and related mortality. Materials & methods: The national Trauma Quality Improvement Program dataset (2010–2014) was queried. Demographics, injury characteristics and outcomes were compared between patients who developed ARDS and those who did not. Logistic regression models were fitted for the development of ARDS and mortality respectively, adjusting for relevant confounders. Results: In the studied 808,195 TQIP patients, incidence of ARDS decreased over the study years (3–1.1%, p < 0.001), but related mortality increased (18.–21%, p = 0.001). ARDS patients spent an additional 14.7 ± 10.3 days in the hospital, 9.7 ± 7.9 in the ICU, and 6.6 ± 9.4 on mechanical ventilation (all p < 0.001). Older age, male gender, African American race increased risk for ARDS. Age, male gender, lower GCS and higher ISS also increased mortality risk among ARDS patients. Several pre-existing comorbidities including chronic alcohol use, diabetes, smoking, and respiratory disease also increased risk. Conclusion: Although the incidence of ARDS after trauma appears to be declining, mortality is on the rise.