Chou Raymond L, Grigorian Areg, Nahmias Jeffry, Schubl Sebastian D, Delaplain Patrick T, Barrios Cristobal
Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, 8788University of California-Irvine, Orange, CA, USA.
J Intensive Care Med. 2021 May;36(5):584-588. doi: 10.1177/0885066620916170. Epub 2020 Apr 7.
Study incidence and mortality for blunt trauma patients developing acute respiratory distress syndrome (ARDS) across race and insurance.
The National Trauma Data Bank (2007-2015) was queried for blunt trauma patients age 16. Covariates (age 65, injury severity score [ISS] 25, traumatic brain injury, lung injury, pneumonia, severe sepsis, hypotension on admission, and blood transfusion) were included in a multivariable logistic regression analysis.
Despite progress in the treatment for ARDS, it remains a significant concern. Racial differences in response to trauma and ARDS have been inconsistently demonstrated. Since these prior studies, ARDS has been redefined by the Berlin Criteria, advances in care have been made, and health-care accessibility has changed.
Adult blunt trauma patients with ISS > 15 and length of stay ≥ 3 days to examine patients at high risk of ARDS.
There were 28 727 patients with ARDS. Most were white (76.2%), followed by blacks (11.5%), Hispanics (11.3%), and Asians (1.8%). Overall mortality was 20.5%. Compared to whites, blacks (odds ratio [OR]: 1.15, confidence interval [CI]: 1.10-1.20, < .001) had higher risk of ARDS, being Hispanic was protective (OR: 0.80, CI: 0.76-0.83, < .001). Asians with ARDS were at greater risk of death (OR: 1.31, CI: 1.07-1.61, < .05) while being black was not associated with risk of death. Patients with private insurance had less diagnosed ARDS and those with ARDS had lower mortality than other insurances (OR: 0.86, CI: 0.79-0.92, < .001).
Data from the National Trauma Data Bank (2007-2015) demonstrates racial and insurance disparities in the development of ARDS in blunt trauma patients. When compared to whites, blacks are at higher risk of developing ARDS while being Hispanic is protective. Likewise, Asians are at greatest risk of death and blacks have no difference in mortality when compared to whites. Patients with private insurance have lower risk of incidence and mortality.
研究钝性创伤患者发生急性呼吸窘迫综合征（ARDS）的发病率和死亡率，涉及不同种族和保险类型。
查询国家创伤数据库（2007 - 2015年）中16岁以上的钝性创伤患者。协变量（年龄≥65岁、损伤严重程度评分[ISS]≥25、创伤性脑损伤、肺损伤、肺炎、严重脓毒症、入院时低血压和输血）纳入多变量逻辑回归分析。
尽管ARDS治疗取得进展，但仍是一个重大问题。创伤和ARDS反应中的种族差异表现并不一致。自这些先前研究以来，ARDS已由柏林标准重新定义，护理方面取得进展，医疗可及性也发生了变化。
损伤严重程度评分（ISS）>15且住院时间≥3天的成年钝性创伤患者，以检查ARDS高危患者。
有28727例ARDS患者。大多数为白人（76.2%），其次是黑人（11.5%）、西班牙裔（11.3%）和亚洲人（1.8%）。总体死亡率为20.5%。与白人相比，黑人发生ARDS的风险更高（优势比[OR]：1.15，置信区间[CI]：1.10 - 1.20，P<0.001），西班牙裔具有保护作用（OR：0.80，CI：0.76 - 0.83，P<0.001）。患ARDS的亚洲人死亡风险更高（OR：1.31，CI：1.07 - 1.61，P<0.05），而黑人与死亡风险无关。有私人保险的患者诊断出ARDS的较少，且患ARDS的患者死亡率低于其他保险类型（OR：0.86，CI：0.79 - 0.92，P<0.001）。
国家创伤数据库（2007 - 2015年）的数据表明，钝性创伤患者发生ARDS存在种族和保险差异。与白人相比，黑人发生ARDS的风险更高，而西班牙裔具有保护作用。同样，亚洲人死亡风险最高，与白人相比黑人死亡率无差异。有私人保险的患者发病和死亡风险较低。
