title: Impact of acute lung injury and acute respiratory distress syndrome after traumatic brain injury in the United States.
abstract: BACKGROUND
  Traumatic brain injury (TBI) is a major cause of disability, morbidity, and mortality. The effect of the acute respiratory distress syndrome and acute lung injury (ARDS/ALI) on in-hospital mortality after TBI remains controversial.
  
  
  OBJECTIVE
  To determine the epidemiology of ARDS/ALI, the prevalence of risk factors, and impact on in-hospital mortality after TBI in the United States.
  
  
  METHODS
  Retrospective cohort study of admissions of adult patients>18 years with a diagnosis of TBI and ARDS/ALI from 1988 to 2008 identified through the Nationwide Inpatient Sample.
  
  
  RESULTS
  During the 20-year study period, the prevalence of ARDS/ALI increased from 2% (95% confidence interval [CI], 2.1%-2.4%) in 1988 to 22% (95% CI, 21%-22%) in 2008 (P<.001). ARDS/ALI was more common in younger age; males; white race; later year of admission; in conjunction with comorbidities such as congestive heart failure, hypertension, chronic obstructive pulmonary disease, chronic renal and liver failure, sepsis, multiorgan dysfunction; and nonrural, medium/large hospitals, located in the Midwest, South, and West continental US location. Mortality after TBI decreased from 13% (95% CI, 12%-14%) in 1988 to 9% (95% CI, 9%-10%) in 2008 (P<.001). ARDS/ALI-related mortality after TBI decreased from 33% (95% CI, 33%-34%) in 1988 to 28% (95% CI, 28%-29%) in 2008 (P<.001). Predictors of in-hospital mortality after TBI were older age, male sex, white race, cancer, chronic kidney disease, hypertension, chronic liver disease, congestive heart failure, ARDS/ALI, and organ dysfunctions.
  
  
  CONCLUSIONS
  Our analysis demonstrates that ARDS/ALI is common after TBI. Despite an overall reduction of in-hospital mortality, ARDS/ALI carries a higher risk of in-hospital death after TBI.
authors.affiliation: Department of Neurology, Division of Critical Care, Thomas Jefferson University, Jefferson College of Medicine, Philadelphia, Pennsylvania 19107, USA. fred.rincon@jefferson.edu
authors.forename: Fred
authors.initials: F
authors.lastname: Rincon
authors.forename: Sayantani
authors.initials: S
authors.lastname: Ghosh
authors.forename: Saugat
authors.initials: S
authors.lastname: Dey
authors.forename: Mitchell
authors.initials: M
authors.lastname: Maltenfort
authors.forename: Matthew
authors.initials: M
authors.lastname: Vibbert
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Urtecho
authors.forename: William
authors.initials: W
authors.lastname: McBride
authors.forename: Michael
authors.initials: M
authors.lastname: Moussouttas
authors.forename: Rodney
authors.initials: R
authors.lastname: Bell
authors.forename: John K
authors.initials: JK
authors.lastname: Ratliff
authors.forename: Jack
authors.initials: J
authors.lastname: Jallo
mesh_terms: D055371:Acute Lung Injury / Q000453:epidemiology* / Q000209:etiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D016009:Chi-Square Distribution; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D038801:International Classification of Diseases; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012128:Respiratory Distress Syndrome / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014965:X-Rays