title: Thoracic trauma and acute respiratory distress syndrome in polytraumatized patients: a retrospective analysis.
abstract: BACKGROUND
  Although thoracic trauma has often been associated with the development of acute respiratory distress syndrome (ARDS) in general, its impact on ARDS in combination with severe concomitant injuries has still to be elucidated. Therefore, the objective of this study was to determine the frequency of thoracic trauma and ARDS in polytraumatized patients, and to evaluate the impact of thoracic trauma on the occurrence and the onset of ARDS.
  
  
  METHODS
  Included in this retrospective cohort study were all polytraumatized patients over 18 years of age, with an injury severity score (ISS) of at least 16, who were admitted to our level I trauma center over a three-year time period.
  
  
  RESULTS
  Two hundred and eighty-eight patients met the inclusion criteria. 54.9% suffered from thoracic trauma, 51.7% developed ARDS, 21.5% pneumonia and 0.7% pulmonary embolism. Independent of the ISS, the presence of thoracic trauma increased the odds of ARDS occurrence (OR=2.242; 95% CI: 1.381-3.640; P<0.001) and resulted in a significantly earlier onset of ARDS (median, day 2 vs. day 3; P<0.01). Of those patients suffering from ARDS, ventilation time and length of stay at the ICU were longer if a concomitant thoracic injury was present (P<0.001). In general, ARDS was diagnosed prior to pneumonia and was therefore identified as its risk factor (OR=11.033; 95% CI: 4.812-25.299; P<0.001). Finally, an overall mortality rate of 21.2% was observed, which was neither affected by thoracic trauma nor ARDS.
  
  
  CONCLUSIONS
  Thoracic trauma was identified as major risk factor for ARDS occurrence and earlier onset in polytrauma victims.
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Haider
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Halat
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Heinz
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hajdu
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria - lukas.negrin@meduniwien.ac.at.
authors.forename: Lukas L
authors.initials: LL
authors.lastname: Negrin
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications*; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D013898:Thoracic Injuries / Q000150:complications* / Q000453:epidemiology