title: Timing of the onset of acute respiratory distress syndrome: a population-based study.
abstract: BACKGROUND
  Many patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) have had recent healthcare interventions prior to developing ALI/ARDS.
  
  
  OBJECTIVE
  To determine the timing of ALI/ARDS onset in relation to hospital admission and other healthcare interventions.
  
  
  METHODS
  We conducted a population-based observational cohort study with a validated electronic surveillance tool, and identified patients with possible ALI/ARDS among critically ill adults at Mayo Clinic hospitals that provide critical care services for Olmsted County, Minnesota, in 2006. Trained investigators independently reviewed electronic medical records and confirmed the presence and timing of ALI/ARDS based on the American-European consensus definition.
  
  
  RESULTS
  Of 124 episodes of ALI in 118 patients, only 5 did not fulfill the ARDS criteria. The syndrome developed a median 30 hours (IQR 10-82 h) after hospital admission in 79 patients (67%). ARDS was present on admission in 39 patients (33%), of whom 14 had recent hospitalization, 6 were transferred from nursing homes, and 3 had recent out-patient contact (1 antibiotic prescription, 1 surgical intervention, and 1 chemotherapy). Only 16 ARDS patients (14%) did not have known recent contact with a healthcare system. Compared to ARDS on admission, hospital-acquired ARDS was more likely to occur in surgery patients (54% vs 15%, P < .001), and had longer adjusted hospital stay (mean difference 8.9 d, 95% CI 0.3-17.4, P = .04).
  
  
  CONCLUSIONS
  ARDS in the community most often develops either during hospitalization or in patients who recently had contact with a healthcare system. These findings have important implications for potential preventive strategies.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Giath
authors.initials: G
authors.lastname: Shari
authors.forename: Marija
authors.initials: M
authors.lastname: Kojicic
authors.forename: Guangxi
authors.initials: G
authors.lastname: Li
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Cartin-Ceba
authors.forename: Cesar Trillo
authors.initials: CT
authors.lastname: Alvarez
authors.forename: Rahul
authors.initials: R
authors.lastname: Kashyap
authors.forename: Yue
authors.initials: Y
authors.lastname: Dong
authors.forename: Jaise T
authors.initials: JT
authors.lastname: Poulose
authors.forename: Vitaly
authors.initials: V
authors.lastname: Herasevich
authors.forename: Javier A Cabello
authors.initials: JA
authors.lastname: Garza
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011159:Population Surveillance; D012128:Respiratory Distress Syndrome / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors