title: Trauma indices for prediction of acute respiratory distress syndrome.
abstract: BACKGROUND
  A myriad of trauma indices has been validated to predict probability of trauma survival. We aimed to compare the performance of commonly used indices for the development of the acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  Historic, observational cohort study of 27,385 consecutive patients admitted to a statewide referral trauma center between July 11, 2003 and October 31, 2011. A validated algorithm was adapted to identify patients with ARDS. Each trauma index was evaluated in logistic regression using the area under the receiver operating characteristic curve.
  
  
  RESULTS
  The case rate for ARDS development was 5.8% (1594). The receiver operating characteristics for injury severity score (ISS) had the best discrimination and had an area under the curve of 0.88 (95% confidence interval [CI] = 0.87-0.89). Glasgow coma score (0.71, 95% CI = 0.70-0.73), A Severity Characterization of Trauma (0.86, 95% CI = 0.85-0.87), Revised Trauma Score (0.71, 95% CI = 0.70-0.72) and thorax Abbreviated Injury Score (0.73, 95% CI = 0.72-0.74) performed worse (P < 0.001) and Trauma and Injury Severity Score (0.88, 95% CI = 0.87-0.88) performed equivocally (P = 0.51) in comparison to ISS. Using a cutoff point ISS ≥16, sensitivity and specificity were 84.9% (95% CI = 83.0%-86.6%) and 75.6% (95% CI = 75.1%-76.2%), respectively.
  
  
  CONCLUSIONS
  Among commonly used trauma indices, ISS has superior or equivocal discriminative ability for development of ARDS. A cutoff point of ISS ≥16 provided good sensitivity and specificity. The use of ISS ≥16 is a simple method to evaluate ARDS in trauma epidemiology and outcomes research.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Loyola University Chicago, Maywood, Illinois; Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois. Electronic address: majid_afshar@luhs.org.
authors.forename: Majid
authors.initials: M
authors.lastname: Afshar
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland; Shock Trauma and Anesthesiology Research (STAR)-Organized Research Center, Department of Surgery, University of Maryland, Baltimore, Maryland.
authors.forename: Gordon S
authors.initials: GS
authors.lastname: Smith
authors.affiliation: Shock Trauma and Anesthesiology Research (STAR)-Organized Research Center, Department of Surgery, University of Maryland, Baltimore, Maryland.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Cooper
authors.affiliation: Program in Trauma, R. Adams Cowley Shock Trauma Center, Department of Surgery, University of Maryland, Baltimore, Maryland.
authors.forename: Sarah
authors.initials: S
authors.lastname: Murthi
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland, Baltimore, Maryland.
authors.forename: Giora
authors.initials: G
authors.lastname: Netzer
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome; D012680:Sensitivity and Specificity; D015599:Trauma Severity Indices; D055815:Young Adult
keywords: Acute lung injury (ALI); Acute respiratory distress syndrome (ARDS); Critical care; Glasgow coma score (GCS); Injury severity score (ISS); trauma