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.

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