Epidemiology, risk factors, and outcomes associated with pediatric acute respiratory distress syndrome in the Trauma Quality Improvement Program database.

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Abstract: Introduction: Acute respiratory distress syndrome (ARDS) occurs in the setting of trauma through multiple mechanisms. Previous systematic reviews have demonstrated a 4% pediatric ARDS (pARDS) incidence in trauma patients in intensive care units and that pARDS is associated with five-fold higher mortality rates compared to those without pARDS. However, most studies do not include recent data. We sought to describe the recent incidence, risk factors, and outcomes of pARDS in the pediatric trauma population. Methods: We analyzed data from the 2017-2023 Trauma Quality Improvement Program (TQIP) dataset for children <18 years of age. ARDS is captured as a core quality metric. We used descriptive, inferential, and multivariable logistic regression (MVLR) analyses. Results: From 2017 to 2023, there were 867,586 that met inclusion, of whom, 589 were documented to have pARDS. The overall incidence was 7 per 10,000 children. By age groups ≤4, 5-9, 10-14, and 15-17, the incidence was 4, 3, 6, 15 per 10,000 children, respectively. Among those with pARDS, the most common mechanism of injury was collisions (70%) followed by firearms (17%). Median composite injury severity scores were higher among those with pARDS (27 [19-38] versus 4 [4-9], p<0.001). The most common injured body regions were the head/neck (70% versus 27%), thorax (71% versus 11%), and skin (75% versus 50%, all p<0.001). Survival was lower among those with pARDS (76% versus 99%, p<0.001). Injuries to the head and neck (OR 4.07, 3.26-5.08) and thorax (OR 7.18, 6.21-9.83) were more commonly associated with a diagnosis of pARDS. In-hospital events such as cardiac arrest (9.44, 7.20-12.36), pulmonary embolism (3.55, 1.80-7.01), acute kidney injury (3.52, 2.13-5.82), sepsis (10.22, 6.12-17.05), and ventilator-associated pneumonia (21.54, 16.37-28.36) were associated with a diagnosis of pARDS. Conclusions: The overall incidence of pARDS in pediatric trauma patients was low, however pARDS was associated with increased in-hospital events, such as cardiac arrest, pulmonary embolism, acute kidney injury, ventilator associated pneumonia, and increased mortality when compared to those without pARDS. The overall low pARDS incidence compared to previous reports suggests that under-detection or under-coding is occurring with current TQIP data. Expanded data collection in the TQIP database is needed to better characterize pARDS and improve care for pediatric trauma patients.

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