A comparison of acute respiratory distress syndrome outcomes between military and civilian burn patients.
BACKGROUND
The objective of this report was to compare the prevalence of acute respiratory distress syndrome (ARDS) and associated mortality between military service members with burns sustained during or in support of combat operations and civilian burn patients treated at a single burn center.


METHODS
Demographic and physiologic data were collected retrospectively on mechanically ventilated military and civilian patients admitted to our burn intensive care unit between January 2003 and December 2011. Patients with ARDS were identified and categorized as mild, moderate, or severe using the Berlin criteria. Demographics and clinical outcomes were compared. After initial comparison, propensity matching was performed and mortality compared.


RESULTS
A total of 891 burn patients required mechanical ventilation during the study period; 291 military and 600 civilian. The prevalence of ARDS was 34% (n=304) for the entire cohort, 33% (n=96) for military, and 35% (n=208) for civilians (p=0.55). For the entire cohort, despite more severe injury burden, military patients had a significantly lower overall mortality (17% vs. 28%; p=0.0002) as well as ARDS mortality (33 vs. 48%, p=0.02) when compared to civilians. This difference was not significant after propensity matching based on age.


CONCLUSIONS
In a retrospective cohort study, burned military patients on mechanical ventilation had a significantly lower overall and ARDS mortality despite larger burns and more severe injury when compared to civilian burn patients. This difference appears to be largely because of age.
United States Army Institute of Surgical Research, 3698 Chambers Pass Road, Suite B, Joint Base San Antonio, Fort Sam Houston, TX 78234-7767.
J Alan
JA
Waters
United States Army Institute of Surgical Research, 3698 Chambers Pass Road, Suite B, Joint Base San Antonio, Fort Sam Houston, TX 78234-7767.
Jonathan B
JB
Lundy
United States Army Institute of Surgical Research, 3698 Chambers Pass Road, Suite B, Joint Base San Antonio, Fort Sam Houston, TX 78234-7767.
James K
JK
Aden
Department of Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Joint Base San Antonio, Fort Sam Houston, TX 78234-4504.
Christy R
CR
Sine
Department of Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Joint Base San Antonio, Fort Sam Houston, TX 78234-4504.
Allison R
AR
Buel
Department of Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Joint Base San Antonio, Fort Sam Houston, TX 78234-4504.
Jonathan L
JL
Henderson
Department of Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Joint Base San Antonio, Fort Sam Houston, TX 78234-4504.
Ian J
IJ
Stewart
Department of Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Joint Base San Antonio, Fort Sam Houston, TX 78234-4504.
Jeremy W
JW
Cannon
United States Army Institute of Surgical Research, 3698 Chambers Pass Road, Suite B, Joint Base San Antonio, Fort Sam Houston, TX 78234-7767.
Andriy
A
Batchinsky
United States Army Institute of Surgical Research, 3698 Chambers Pass Road, Suite B, Joint Base San Antonio, Fort Sam Houston, TX 78234-7767.
Leopoldo C
LC
Cancio
United States Army Institute of Surgical Research, 3698 Chambers Pass Road, Suite B, Joint Base San Antonio, Fort Sam Houston, TX 78234-7767.
Kevin K
KK
Chung
D000328:Adult; D002056:Burns / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D015995:Prevalence; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology