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Randomized Controlled Trial
. 2016 Feb;80(2):308-12.
doi: 10.1097/TA.0000000000000903.

The incidence of ARDS and associated mortality in severe TBI using the Berlin definition

Imoigele P Aisiku  1 , Jose-Miguel Yamal, Pratik Doshi, Maria Laura Rubin, Julia S Benoit, Julia Hannay, Barbara C Tilley, Shankar Gopinath, Claudia S Robertson
Affiliations
Randomized Controlled Trial

The incidence of ARDS and associated mortality in severe TBI using the Berlin definition

Imoigele P Aisiku et al. J Trauma Acute Care Surg. 2016 Feb.

Abstract

Background: The incidence of adult respiratory distress syndrome (ARDS) in severe traumatic brain injury (TBI) is poorly reported. Recently, a new definition for ARDS was proposed, the Berlin definition. The percentage of patients represented by TBI in the Berlin criteria study is limited. This study describes the incidence and associated mortality of ARDS in TBI patients.

Methods: The study was an analysis of the safety of erythropoietin administration and transfusion threshold on the incidence of ARDS in severe TBI patients. Three reviewers independently assessed all patients enrolled in the study for acute lung injury/ARDS using the Berlin and the American-European Consensus Conference (AECC) definitions. A Cox proportional hazards model was used to assess the relationship between ARDS and mortality and 6-month Glasgow Outcome Scale (GOS) score.

Results: Two hundred patients were enrolled in the study. Of the patients, 21% (41 of 200) and 26% (52 of 200) developed ARDS using the AECC and Berlin definitions, respectively, with a median time of 3 days (interquartile range, 3) after injury. ARDS by either definition was associated with increased mortality (p = 0.04) but not with differences in functional outcome as measured by the GOS score at 6 months. Adjusted analysis using the Berlin criteria showed an increased mortality associated with ADS (p = 0.01).

Conclusion: Severe TBI is associated with an incidence of ARDS ranging from 20% to 25%. The incidence is comparable between the Berlin and AECC definitions. ARDS is associated with increased mortality in severe TBI patients, but further studies are needed to validate these findings.

Level of evidence: Epidemiologic study, level II.

Trial registration: ClinicalTrials.gov NCT00313716.

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Conflict of interest statement

No conflict of interests for all authors

References

    1. Sosin DM, Sacks JJ, Smith SM. Head injury-associated deaths in the United States from 1979 to 1986. JAMA. 1989;262:2251–5. - PubMed
    1. Bratton SL, Davis RL. Acute lung injury in isolated traumatic brain injury. Neurosurgery. 1997;40:707–12. discussion 12. - PubMed
    1. Holland MC, Mackersie RC, Morabito D, Campbell AR, Kivett VA, Patel R, Erickson VR, Pittet JF. The development of acute lung injury is associated with worse neurologic outcome in patients with severe traumatic brain injury. J Trauma. 2003;55:106–11. - PubMed
    1. Acker JE, 3rd, Pancioli AM, Crocco TJ, Eckstein MK, Jauch EC, Larrabee H, Meltzer NM, Mergendahl WC, Munn JW, Prentiss SM, et al. Implementation strategies for emergency medical services within stroke systems of care: a policy statement from the American Heart Association/American Stroke Association Expert Panel on Emergency Medical Services Systems and the Stroke Council. Stroke. 2007;38:3097–115. - PubMed
    1. Rincon F, Ghosh S, Dey S, Maltenfort M, Vibbert M, Urtecho J, McBride W, Moussouttas M, Bell R, Ratliff JK, Jallo J. Impact of acute lung injury and acute respiratory distress syndrome after traumatic brain injury in the United States. Neurosurgery. 2012;71:795–803. - PubMed

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