Incidence, risk factors, and mortality associated with acute respiratory distress syndrome in combat casualty care
The overall incidence and mortality of acute respiratory distress syndrome (ARDS) in civilian trauma settings have decreased over the past four decades; however, the epidemiology and impact of ARDS on modern combat casualty care are unknown. We sought to determine the incidence, risk factors, resour...
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| Veröffentlicht in: | The journal of trauma and acute care surgery 2016-11, Vol.81 (5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium), p.S150-S156 |
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| container_issue | 5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium |
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| container_title | The journal of trauma and acute care surgery |
| container_volume | 81 |
| creator | Park, Pauline K Cannon, Jeremy W Ye, Wen Blackbourne, Lorne H Holcomb, John B Beninati, William Napolitano, Lena M |
| description | The overall incidence and mortality of acute respiratory distress syndrome (ARDS) in civilian trauma settings have decreased over the past four decades; however, the epidemiology and impact of ARDS on modern combat casualty care are unknown. We sought to determine the incidence, risk factors, resource utilization, and mortality associated with ARDS in current combat casualty care.
This was a retrospective review of mechanically ventilated US combat casualties within the Department of Defense Trauma Registry (formerly the Joint Theater Trauma Registry) during Operation Iraqi Freedom/Enduring Freedom (October 2001 to August 2008) for ARDS development, resource utilization, and mortality.
Of 18,329 US Department of Defense Trauma Registry encounters, 4,679 (25.5%) required mechanical ventilation; ARDS was identified in 156 encounters (3.3%). On multivariate logistic regression, ARDS was independently associated with female sex (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.21-5.71; p = 0.02), higher military-specific Injury Severity Score (Mil ISS) (OR, 4.18; 95% CI, 2.61-6.71; p < 0.001 for Mil ISS ≥25 vs. |
| doi_str_mv | 10.1097/TA.0000000000001183 |
| format | Article |
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This was a retrospective review of mechanically ventilated US combat casualties within the Department of Defense Trauma Registry (formerly the Joint Theater Trauma Registry) during Operation Iraqi Freedom/Enduring Freedom (October 2001 to August 2008) for ARDS development, resource utilization, and mortality.
Of 18,329 US Department of Defense Trauma Registry encounters, 4,679 (25.5%) required mechanical ventilation; ARDS was identified in 156 encounters (3.3%). On multivariate logistic regression, ARDS was independently associated with female sex (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.21-5.71; p = 0.02), higher military-specific Injury Severity Score (Mil ISS) (OR, 4.18; 95% CI, 2.61-6.71; p < 0.001 for Mil ISS ≥25 vs. <15), hypotension (admission systolic blood pressure <90 vs. ≥90 mm Hg; OR, 1.76; 95% CI, 1.07-2.88; p = 0.03), and tachycardia (admission heart rate ≥90 vs. <90 beats per minute; OR, 1.53; 95% CI, 1.06-2.22; p = 0.02). Explosion injury was not associated with increased risk of ARDS. Critical care resource utilization was significantly higher in ARDS patients as was all-cause hospital mortality (ARDS vs. no ARDS, 12.8% vs. 5.9%; p = 0.002). After adjustment for age, sex, injury severity, injury mechanism, Mil ISS, hypotension, tachycardia, and admission Glasgow Coma Scale score, ARDS remained an independent risk factor for death (OR, 1.99; 95% CI, 1.12-3.52; p = 0.02).
In this large cohort of modern combat casualties, ARDS risk factors included female sex, higher injury severity, hypotension, and tachycardia, but not explosion injury. Patients with ARDS also required more medical resources and were at greater risk of death compared with patients without ARDS. Thus, ARDS remains a significant complication in current combat casualty care.
Prognostic/epidemiologic study, level III.</description><identifier>ISSN: 2163-0755</identifier><identifier>EISSN: 2163-0763</identifier><identifier>DOI: 10.1097/TA.0000000000001183</identifier><identifier>PMID: 27768663</identifier><language>eng</language><publisher>United States</publisher><subject>Adolescent ; Adult ; Armed Conflicts ; Female ; Humans ; Hypotension - complications ; Incidence ; Injury Severity Score ; Logistic Models ; Male ; Middle Aged ; Military Personnel ; Respiratory Distress Syndrome, Adult - epidemiology ; Respiratory Distress Syndrome, Adult - etiology ; Respiratory Distress Syndrome, Adult - mortality ; Retrospective Studies ; Risk Factors ; Tachycardia - complications ; United States ; Young Adult</subject><ispartof>The journal of trauma and acute care surgery, 2016-11, Vol.81 (5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium), p.S150-S156</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c305t-e8139277c6cf9a7d95da7e3bbc72c7f903903542781e06f9d9857e8ae39f25f93</citedby><cites>FETCH-LOGICAL-c305t-e8139277c6cf9a7d95da7e3bbc72c7f903903542781e06f9d9857e8ae39f25f93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27768663$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Park, Pauline K</creatorcontrib><creatorcontrib>Cannon, Jeremy W</creatorcontrib><creatorcontrib>Ye, Wen</creatorcontrib><creatorcontrib>Blackbourne, Lorne H</creatorcontrib><creatorcontrib>Holcomb, John B</creatorcontrib><creatorcontrib>Beninati, William</creatorcontrib><creatorcontrib>Napolitano, Lena M</creatorcontrib><title>Incidence, risk factors, and mortality associated with acute respiratory distress syndrome in combat casualty care</title><title>The journal of trauma and acute care surgery</title><addtitle>J Trauma Acute Care Surg</addtitle><description>The overall incidence and mortality of acute respiratory distress syndrome (ARDS) in civilian trauma settings have decreased over the past four decades; however, the epidemiology and impact of ARDS on modern combat casualty care are unknown. We sought to determine the incidence, risk factors, resource utilization, and mortality associated with ARDS in current combat casualty care.
This was a retrospective review of mechanically ventilated US combat casualties within the Department of Defense Trauma Registry (formerly the Joint Theater Trauma Registry) during Operation Iraqi Freedom/Enduring Freedom (October 2001 to August 2008) for ARDS development, resource utilization, and mortality.
Of 18,329 US Department of Defense Trauma Registry encounters, 4,679 (25.5%) required mechanical ventilation; ARDS was identified in 156 encounters (3.3%). On multivariate logistic regression, ARDS was independently associated with female sex (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.21-5.71; p = 0.02), higher military-specific Injury Severity Score (Mil ISS) (OR, 4.18; 95% CI, 2.61-6.71; p < 0.001 for Mil ISS ≥25 vs. <15), hypotension (admission systolic blood pressure <90 vs. ≥90 mm Hg; OR, 1.76; 95% CI, 1.07-2.88; p = 0.03), and tachycardia (admission heart rate ≥90 vs. <90 beats per minute; OR, 1.53; 95% CI, 1.06-2.22; p = 0.02). Explosion injury was not associated with increased risk of ARDS. Critical care resource utilization was significantly higher in ARDS patients as was all-cause hospital mortality (ARDS vs. no ARDS, 12.8% vs. 5.9%; p = 0.002). After adjustment for age, sex, injury severity, injury mechanism, Mil ISS, hypotension, tachycardia, and admission Glasgow Coma Scale score, ARDS remained an independent risk factor for death (OR, 1.99; 95% CI, 1.12-3.52; p = 0.02).
In this large cohort of modern combat casualties, ARDS risk factors included female sex, higher injury severity, hypotension, and tachycardia, but not explosion injury. Patients with ARDS also required more medical resources and were at greater risk of death compared with patients without ARDS. Thus, ARDS remains a significant complication in current combat casualty care.
Prognostic/epidemiologic study, level III.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Armed Conflicts</subject><subject>Female</subject><subject>Humans</subject><subject>Hypotension - complications</subject><subject>Incidence</subject><subject>Injury Severity Score</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Military Personnel</subject><subject>Respiratory Distress Syndrome, Adult - epidemiology</subject><subject>Respiratory Distress Syndrome, Adult - etiology</subject><subject>Respiratory Distress Syndrome, Adult - mortality</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Tachycardia - complications</subject><subject>United States</subject><subject>Young Adult</subject><issn>2163-0755</issn><issn>2163-0763</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkE1LBDEMhosouqi_QJAePezodGqn0-MifoHgZT0PmTaD1flYmw4y_94uqyKGQBJ43yQ8jJ2J_FLkRl-tV5f5nxCikntsUYhSZrku5f5vr9QROyV626pUaaRSh-yo0LqsylIuWHgcrHc4WFzy4Omdt2DjGGjJYXC8H0OEzseZA9FoPUR0_NPHVw52isgD0sYHSIaZO08xzcRpHlwYe-R-4HbsG4jcAk3QpTUWAp6wgxY6wtPvesxe7m7XNw_Z0_P9483qKbMyVzHDSkiTHrWlbQ1oZ5QDjbJprC6sbk0uU6rrQlcC87I1zlRKYwUoTVuo1shjdrHbuwnjx4QU696Txa6DAceJ6oRMKVElREkqd1IbRqKAbb0Jvocw1yKvt7zr9ar-zzu5zr8PTE2P7tfzQ1d-AWK5fEM</recordid><startdate>20161101</startdate><enddate>20161101</enddate><creator>Park, Pauline K</creator><creator>Cannon, Jeremy W</creator><creator>Ye, Wen</creator><creator>Blackbourne, Lorne H</creator><creator>Holcomb, John B</creator><creator>Beninati, William</creator><creator>Napolitano, Lena M</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20161101</creationdate><title>Incidence, risk factors, and mortality associated with acute respiratory distress syndrome in combat casualty care</title><author>Park, Pauline K ; Cannon, Jeremy W ; Ye, Wen ; Blackbourne, Lorne H ; Holcomb, John B ; Beninati, William ; Napolitano, Lena M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c305t-e8139277c6cf9a7d95da7e3bbc72c7f903903542781e06f9d9857e8ae39f25f93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Armed Conflicts</topic><topic>Female</topic><topic>Humans</topic><topic>Hypotension - complications</topic><topic>Incidence</topic><topic>Injury Severity Score</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Military Personnel</topic><topic>Respiratory Distress Syndrome, Adult - epidemiology</topic><topic>Respiratory Distress Syndrome, Adult - etiology</topic><topic>Respiratory Distress Syndrome, Adult - mortality</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Tachycardia - complications</topic><topic>United States</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Park, Pauline K</creatorcontrib><creatorcontrib>Cannon, Jeremy W</creatorcontrib><creatorcontrib>Ye, Wen</creatorcontrib><creatorcontrib>Blackbourne, Lorne H</creatorcontrib><creatorcontrib>Holcomb, John B</creatorcontrib><creatorcontrib>Beninati, William</creatorcontrib><creatorcontrib>Napolitano, Lena M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of trauma and acute care surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Park, Pauline K</au><au>Cannon, Jeremy W</au><au>Ye, Wen</au><au>Blackbourne, Lorne H</au><au>Holcomb, John B</au><au>Beninati, William</au><au>Napolitano, Lena M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence, risk factors, and mortality associated with acute respiratory distress syndrome in combat casualty care</atitle><jtitle>The journal of trauma and acute care surgery</jtitle><addtitle>J Trauma Acute Care Surg</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>81</volume><issue>5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium</issue><spage>S150</spage><epage>S156</epage><pages>S150-S156</pages><issn>2163-0755</issn><eissn>2163-0763</eissn><abstract>The overall incidence and mortality of acute respiratory distress syndrome (ARDS) in civilian trauma settings have decreased over the past four decades; however, the epidemiology and impact of ARDS on modern combat casualty care are unknown. We sought to determine the incidence, risk factors, resource utilization, and mortality associated with ARDS in current combat casualty care.
This was a retrospective review of mechanically ventilated US combat casualties within the Department of Defense Trauma Registry (formerly the Joint Theater Trauma Registry) during Operation Iraqi Freedom/Enduring Freedom (October 2001 to August 2008) for ARDS development, resource utilization, and mortality.
Of 18,329 US Department of Defense Trauma Registry encounters, 4,679 (25.5%) required mechanical ventilation; ARDS was identified in 156 encounters (3.3%). On multivariate logistic regression, ARDS was independently associated with female sex (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.21-5.71; p = 0.02), higher military-specific Injury Severity Score (Mil ISS) (OR, 4.18; 95% CI, 2.61-6.71; p < 0.001 for Mil ISS ≥25 vs. <15), hypotension (admission systolic blood pressure <90 vs. ≥90 mm Hg; OR, 1.76; 95% CI, 1.07-2.88; p = 0.03), and tachycardia (admission heart rate ≥90 vs. <90 beats per minute; OR, 1.53; 95% CI, 1.06-2.22; p = 0.02). Explosion injury was not associated with increased risk of ARDS. Critical care resource utilization was significantly higher in ARDS patients as was all-cause hospital mortality (ARDS vs. no ARDS, 12.8% vs. 5.9%; p = 0.002). After adjustment for age, sex, injury severity, injury mechanism, Mil ISS, hypotension, tachycardia, and admission Glasgow Coma Scale score, ARDS remained an independent risk factor for death (OR, 1.99; 95% CI, 1.12-3.52; p = 0.02).
In this large cohort of modern combat casualties, ARDS risk factors included female sex, higher injury severity, hypotension, and tachycardia, but not explosion injury. Patients with ARDS also required more medical resources and were at greater risk of death compared with patients without ARDS. Thus, ARDS remains a significant complication in current combat casualty care.
Prognostic/epidemiologic study, level III.</abstract><cop>United States</cop><pmid>27768663</pmid><doi>10.1097/TA.0000000000001183</doi></addata></record> |
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| ispartof | The journal of trauma and acute care surgery, 2016-11, Vol.81 (5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium), p.S150-S156 |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adolescent Adult Armed Conflicts Female Humans Hypotension - complications Incidence Injury Severity Score Logistic Models Male Middle Aged Military Personnel Respiratory Distress Syndrome, Adult - epidemiology Respiratory Distress Syndrome, Adult - etiology Respiratory Distress Syndrome, Adult - mortality Retrospective Studies Risk Factors Tachycardia - complications United States Young Adult |
| title | Incidence, risk factors, and mortality associated with acute respiratory distress syndrome in combat casualty care |
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