创伤后年龄与急性呼吸窘迫综合征发展和死亡率的关系。
Association between age and acute respiratory distress syndrome development and mortality following trauma.
机构信息
From the Harborview Injury Prevention and Research Center (E.Y.K., B.M., M.S.V., G.E.O., F.P.R.), University of Washington, Seattle, Washington; Division of Pediatric Critical Care Medicine, Department of Pediatrics (E.Y.K., R.S.W.), University of Washington, Seattle, Washington; Department of Anesthesiology and Pain Medicine (M.S.V.), University of Washington, Seattle, Washington; Center for Child Health, Behavior, and Development (R.S.W., F.P.R.), Seattle Children's Research Institute, Seattle, Washington; Department of Surgery (G.E.O.), University of Washington, Seattle, Washington; Division of General Pediatrics, Department of Pediatrics (F.P.R.), University of Washington, Seattle, Washington.
出版信息
J Trauma Acute Care Surg. 2019 May;86(5):844-852. doi: 10.1097/TA.0000000000002202.
BACKGROUND
Improved understanding of the relationship between patient age and acute respiratory distress syndrome (ARDS) development and mortality following traumatic injury may help facilitate generation of new hypotheses about ARDS pathophysiology and the role of novel treatments to improve outcomes across the age spectrum.
METHODS
We conducted a retrospective cohort study of trauma patients included in the National Trauma Data Bank who were admitted to an intensive care unit from 2007 to 2016. We determined ARDS incidence and mortality across eight age groups for the entire 10-year study period and by year. We used generalized linear Poisson regression models adjusted for underlying mortality risk (injury mechanism, Injury Severity Score, admission Glasgow Coma Scale score, admission heart rate, and admission hypotension).
RESULTS
Acute respiratory distress syndrome occurred in 3.1% of 1,297,190 trauma encounters. Acute respiratory distress syndrome incidence was lowest among pediatric patients and highest among adults aged 35 to 64 years. Acute respiratory distress syndrome mortality was highest among patients 80 years or older (43.9%), followed by 65 to 79 years (30.6%) and 4 years or younger (25.3%). The relative risk of mortality associated with ARDS was highest among the pediatric age groups, with an adjusted relative risk (aRR) of 2.06 (95% confidence interval [CI], 1.72-2.70) among patients 4 years or younger compared with an aRR of 1.51 (95% CI, 1.42-1.62) for the entire cohort. Acute respiratory distress syndrome mortality increased over the 10-year study period (aRR, 1.03 per year; 95% CI, 1.02-1.05 per year), whereas all-cause mortality decreased (aRR, 0.98 per year; 95% CI, 0.98-0.99 per year).
CONCLUSIONS
While ARDS development following traumatic injury was most common in middle-aged adults, patients 4 years or younger and 65 years or older with ARDS experienced the highest burden of mortality. Children 4 years or younger were disproportionately affected by ARDS relative to their low underlying mortality following trauma that was not complicated by ARDS. Acute respiratory distress syndrome-associated mortality following trauma has worsened over the past decade, emphasizing the need for new prevention and treatment strategies.
LEVEL OF EVIDENCE
Prognostic/epidemiological study, level III.
背景
对创伤后患者年龄与急性呼吸窘迫综合征（ARDS）发生和死亡率之间关系的深入了解，可能有助于产生有关 ARDS 病理生理学和新型治疗方法作用的新假说，从而改善各年龄段患者的预后。
方法
我们对 2007 年至 2016 年间纳入国家创伤数据库并入住重症监护病房的创伤患者进行了回顾性队列研究。我们在整个 10 年研究期间和每年按 8 个年龄组确定 ARDS 的发生率和死亡率。我们使用广义线性泊松回归模型，对潜在死亡率风险（损伤机制、损伤严重程度评分、入院格拉斯哥昏迷评分、入院心率和入院低血压）进行了调整。
结果
1297190 例创伤患者中，ARDS 的发生率为 3.1%。儿科患者的 ARDS 发生率最低，35 至 64 岁的成年人发生率最高。80 岁及以上患者的 ARDS 死亡率最高（43.9%），其次是 65 至 79 岁（30.6%）和 4 岁及以下（25.3%）。ARDS 相关死亡率的相对风险在儿科年龄组最高，与整个队列相比，4 岁及以下患者的调整后相对风险（aRR）为 2.06（95%置信区间[CI]，1.72-2.70），而整个队列的 aRR 为 1.51（95%CI，1.42-1.62）。在 10 年研究期间，ARDS 死亡率呈上升趋势（aRR，每年增加 1.03；95%CI，每年增加 1.02-1.05），而全因死亡率呈下降趋势（aRR，每年减少 0.98；95%CI，每年减少 0.98-0.99）。
结论
虽然创伤后 ARDS 的发生在中年成年人中最为常见，但 ARDS 发生在 4 岁及以下和 65 岁及以上的患者中死亡率最高。4 岁及以下儿童患 ARDS 的比例相对较高，而其创伤后死亡率相对较低，且 ARDS 并不复杂。过去十年中，创伤后 ARDS 相关死亡率恶化，强调需要新的预防和治疗策略。
证据水平
预后/流行病学研究，III 级。
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