Association between Age and Acute Respiratory Distress Syndrome Development and Mortality following Trauma

Background 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. Methods 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 2007-2016. 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). Results ARDS occurred in 3.1% of 1,297,190 trauma encounters. ARDS incidence was lowest among pediatric patients and highest among adults ages 35-64. ARDS mortality was highest among patients ≥80 years (43.9%) followed by 65-79 years (30.6%) and ≤4 years (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% CI 1.72-2.70) among patients ≤4 years old compared to an aRR of 1.51 (95% CI 1.42-1.62) for the entire cohort. ARDS mortality increased over the ten-year study period (aRR 1.03/year, 95% CI 1.02-1.05), while all-cause mortality decreased (aRR 0.98/year, 95% CI 0.98-0.99). Conclusions While ARDS development following traumatic injury was most common in middle-aged adults, patients ≤4 years and ≥65 years with ARDS experienced the highest burden of mortality. Children ≤4 years were disproportionately affected by ARDS relative to their low underlying mortality following trauma that was not complicated by ARDS. ARDS-associated mortality following trauma has worsened over the past decade, emphasizing the need for new prevention and treatment strategies. Level of Evidence III, prognostic/epidemiological study Address correspondence to: Elizabeth Y. Killien, MD Harborview Injury Prevention and Research Center Seattle Children’s Hospital Pediatric Critical Care Medicine, FA 2.112 4800 Sand Point Way NE Seattle, WA 98105 Email: elizabeth.killien@seattlechildrens.org Phone: (206) 744-9464 Fax: (206) 987-3866 Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose Meetings at which work presented: None Sources of Funding: Supported by NICHD grant T32 HD057822-08 © 2019 Lippincott Williams & Wilkins, Inc.

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