The incidence of ARDS and associated mortality in severe TBI using the Berlin definition.
BACKGROUND
The incidence of adult respiratory distress syndrome (ARDS) in severe traumatic brain injury (TBI) is poorly reported. Recently, a new definition for ARDS was proposed, the Berlin definition. The percentage of patients represented by TBI in the Berlin criteria study is limited. This study describes the incidence and associated mortality of ARDS in TBI patients.


METHODS
The study was an analysis of the safety of erythropoietin administration and transfusion threshold on the incidence of ARDS in severe TBI patients. Three reviewers independently assessed all patients enrolled in the study for acute lung injury/ARDS using the Berlin and the American-European Consensus Conference (AECC) definitions. A Cox proportional hazards model was used to assess the relationship between ARDS and mortality and 6-month Glasgow Outcome Scale (GOS) score.


RESULTS
Two hundred patients were enrolled in the study. Of the patients, 21% (41 of 200) and 26% (52 of 200) developed ARDS using the AECC and Berlin definitions, respectively, with a median time of 3 days (interquartile range, 3) after injury. ARDS by either definition was associated with increased mortality (p = 0.04) but not with differences in functional outcome as measured by the GOS score at 6 months. Adjusted analysis using the Berlin criteria showed an increased mortality associated with ADS (p = 0.01).


CONCLUSIONS
Severe TBI is associated with an incidence of ARDS ranging from 20% to 25%. The incidence is comparable between the Berlin and AECC definitions. ARDS is associated with increased mortality in severe TBI patients, but further studies are needed to validate these findings.


METHODS
Epidemiologic study, level II.
From the Department of Emergency Medicine (I.P.A.), Brigham and Women's Hospital, Boston, Massachusetts; and Division of Biostatistics (J.M.-Y., M.L.R., B.C.T.), University of Texas School of Public Health; Department of Emergency Medicine and Internal Medicine (P.D.), University of Texas Health Science Center at Houston; Department of Basic Vision Sciences (J.S.B.), College of Optometry Texas Institute for Measurement Evaluation and Statistics, and Department of Psychology (J.H.), University of Houston; and Department of Neurosurgery (S.G., C.S.R.), Baylor College of Medicine, Houston, Texas.
Imoigele P
IP
Aisiku
Jose-Miguel
JM
Yamal
Pratik
P
Doshi
Maria Laura
ML
Rubin
Julia S
JS
Benoit
Julia
J
Hannay
Barbara C
BC
Tilley
Shankar
S
Gopinath
Claudia S
CS
Robertson
D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult
D004921:Erythropoietin