title: The prevalence and impact of mortality of the acute respiratory distress syndrome on admissions of patients with ischemic stroke in the United States.
abstract: OBJECTIVE
  To determine the epidemiology of the acute respiratory distress syndrome (ARDS) and impact on in-hospital mortality in admissions of patients with acute ischemic stroke (AIS) in the United States.
  
  
  METHODS
  Retrospective cohort study of admissions with a diagnosis of AIS and ARDS from 1994 to 2008 identified through the Nationwide Inpatient Sample.
  
  
  RESULTS
  During the 15-year study period, we found 55 58 091 admissions of patients with AIS. The prevalence of ARDS in admissions of patients with AIS increased from 3% in 1994 to 4% in 2008 (P < .001). The ARDS was more common among younger men, nonwhites, and associated with history of congestive heart failure, hypertension, chronic obstructive pulmonary disease, renal failure, chronic liver disease, systemic tissue plasminogen activator, craniotomy, angioplasty or stent, sepsis, and multiorgan failures. Mortality due to AIS and ARDS decreased from 8% in 1994 to 6% in 2008 (P < .001) and 55% in 1994 to 45% in 2008 (P < .001), respectively. The ARDS in AIS increased in-hospital mortality (odds ratio, 14; 95% confidence interval, 13.5-14.3). A significantly higher length of stay was seen in admissions of patients with AIS having ARDS.
  
  
  CONCLUSIONS
  Our analysis demonstrates that ARDS is rare after AIS. Despite an overall significant reduction in mortality after AIS, ARDS carries a higher risk of death in this patient population.
authors.affiliation: Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA fred.rincon@jefferson.edu.
authors.forename: Fred
authors.initials: F
authors.lastname: Rincon
authors.affiliation: Department of Biostatistics, The Rothman Institute, Philadelphia, PA, USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Maltenfort
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Saugat
authors.initials: S
authors.lastname: Dey
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Sayantani
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Vibbert
authors.affiliation: Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Jaqueline
authors.initials: J
authors.lastname: Urtecho
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Jallo
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: John K
authors.initials: JK
authors.lastname: Ratliff
authors.affiliation: Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA Division of Critical Care and Neurotrauma, Thomas Jefferson University, Philadelphia, PA, USA Division of Cerebrovascular Diseases, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: John William
authors.initials: JW
authors.lastname: McBride
authors.affiliation: Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA Division of Critical Care and Neurotrauma, Thomas Jefferson University, Philadelphia, PA, USA Division of Cerebrovascular Diseases, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Rodney
authors.initials: R
authors.lastname: Bell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications*; D015331:Cohort Studies; D015897:Comorbidity; D003422:Critical Care; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D015995:Prevalence; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000209:etiology / Q000401:mortality*; D014481:United States / Q000453:epidemiology
keywords: NIS; epidemiology; hypoxia; nationwide inpatient sample; outcome