The presence of the adult respiratory distress syndrome does not worsen mortality or discharge disability in blunt trauma patients with severe traumatic brain injury.
OBJECTIVE
To evaluate the prevalence of the acute respiratory distress syndrome (ARDS) among blunt trauma patients with severe traumatic brain injury (TBI) and to determine if ARDS is associated with higher mortality, morbidity and worse discharge outcome.


METHODS
Blunt trauma patients with TBI (head abbreviated injury score (AIS)> or =4) who developed predefined ARDS criteria between January 2000 and December 2004 were prospectively collected as part of an ongoing ARDS database. Each patient in the TBI+ARDS group was matched with two control TBI patients based on age, injury severity score (ISS) and head AIS. Outcomes including complications, mortality and discharge disability were compared between the two groups.


RESULTS
Among 362 TBI patients, 28 (7.7%) developed ARDS. There were no differences between the two groups with respect to age, sex, ISS, Glasgow coma score (GCS), head, abdomen and extremity AIS. The TBI+ARDS group had significantly more patients with chest AIS> or =3 (57.1% versus 32.1%, p=0.03). There was no difference with respect to overall mortality between the TBI+ARDS group (50.0%) and the TBI group (51.8%) (OR 0.79: 95% CI 0.31-2.03, p=0.63). There was no significant difference with respect to discharge functional capacity between the two groups. There were significantly more overall complications in the TBI+ARDS group (42.9%) compared to the TBI group (16.1%) (OR 3.66: 95% CI 1.19-11.24, p=0.02). The TBI+ARDS group had an overall mean intensive care unit (ICU) length of stay of 15.6 days, versus 8.4 days in the TBI group (p<0.01). The TBI+ARDS group had significantly higher hospital charges than the TBI group ($210,097 versus $115,342, p<0.01).


CONCLUSIONS
The presence of ARDS was not associated with higher mortality or worse discharge disability. It was, however, associated with higher hospital morbidity, longer ICU and hospital length of stay.
Salim
Ali
A
Department of Surgery, Division of Trauma and Critical Care, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA. asalim@surgery.usc.edu
Martin
Matthew
M
Brown
Carlos
C
Inaba
Kenji
K
Browder
Timothy
T
Rhee
Peter
P
Teixeira
Pedro G R
PG
Demetriades
Demetrios
D
D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000209:etiology; D011237:Predictive Value of Tests; D018121:Receptors, Cytokine / Q000378:metabolism; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000378:metabolism / Q000401:mortality; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000401:mortality
D018121:Receptors, Cytokine