Adult respiratory distress syndrome among blunt and penetrating trauma patients: Demographics, mortality, and resource utilization over 8 years

Purpose: The purpose of this study was to compare demographics, resources u sed, and mortality rates among a subset of trauma patients (blunt versus pe netrating) who developed adult respiratory distress syndrome (ARDS) and ove r two time periods, 8 years apart. Patients and Methods: This retrospective observational study was based on a n analysis of the computerized Trauma Registry of the Shock Trauma Center o f the University of Maryland Medical Systems. All trauma patients with ARDS admitted to a 48-bed trauma intensive care unit (ICU) at a Level I Trauma Center during two time periods of 3 consecutive years each were considered: from January 1, 1985, to December 31, 1987 (G1), and January 1, 1993, to D ecember 31, 1995 (G2). Data were collected in the two time periods on demog raphics, severity (Revised Trauma Score), injury-admission delay time, firs t 24-hour transfusion fluids and blood, septic and organ system failure com plications, life-support techniques, ICU mortality, and length of stay (LOS ). The independent variables were the age, type of trauma, severity scores, transport time, fluid therapy, infectious and organ system failure complic ations, and life-support techniques. The dependent variable was ICU mortali ty. Results: A total of 1,108 patients satisfied the entry criteria, 486 in per iod G1 and 552 in period G2; 929 (89.5%) suffered blunt trauma and 109 (10. 5%) penetrating trauma. Mean age was lower for the penetrating trauma popul ations. There were no significant differences in ICU mortality between the blunt and penetrating trauma patients with ARDS. A significant decrease in ICU mortality was observed between the time periods studied among both blun t (29.5% vs. 21.7%, P < .001) and penetrating trauma patients (25.7% vs. 18 .9%, P < .001). A similar rate of renal, hematologic, and cardiovascular or gan system failure was observed for both blunt and penetrating trauma patie nts. Resource utilization measured by ICU LOS and time on mechanical ventil ation was also similar in the two groups. The multivariate analysis showed that ICU mortality was related to age, RTS-measured severity, and time peri od (G1 mortality 1.68-fold that in G2). Renal and hematologic failures ente red a second analysis, replacing the time period variable (G2). Conclusions: ARDS in patients with blunt and penetrating trauma showed simi lar trends in ICU mortality, complications, and resource utilization. The A RDS mortality rate decreased over the time period studied in both blunt and penetrating trauma. Copyright (C) 2001 by W.B. Saunders Company.