title: Early markers of acute respiratory distress syndrome development in severe trauma patients.
abstract: OBJECTIVE
  The aim of the study was to identify early risk factors for development of acute respiratory distress syndrome (ARDS) in severe trauma patients.
  
  
  METHODS
  This was a prospective observational study of 693 severe trauma patients (Injury Severity Score >or=16 and/or Revised Trauma Score <or=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 (>or=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.
authors.affiliation: Virgen de las Nieves University Hospital, Granada, Spain. pnavarro@ugr.es
authors.forename: Pedro
authors.initials: P
authors.lastname: Navarrete-Navarro
authors.forename: Ricardo
authors.initials: R
authors.lastname: Rivera-Fernández
authors.forename: Ma Dolores
authors.initials: MD
authors.lastname: Rincón-Ferrari
authors.forename: Manuel
authors.initials: M
authors.lastname: García-Delgado
authors.forename: Angeles
authors.initials: A
authors.lastname: Muñoz
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Jiménez
authors.forename: F J Fernández
authors.initials: FJ
authors.lastname: Ortega
authors.forename: Dolores Ma Mayor
authors.initials: DM
authors.lastname: García
mesh_terms: D018806:APACHE; D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D012307:Risk Factors; D014947:Wounds and Injuries / Q000150:complications / Q000503:physiopathology*