Trauma indices for prediction of acute respiratory distress syndrome Journal Article


Authors: Afshar, M.; Smith, G. S.; Cooper, R. S.; Murthi, S.; Netzer, G.
Article Title: Trauma indices for prediction of acute respiratory distress syndrome
Abstract: BACKGROUND: A myriad of trauma indices has been validated to predict probability of trauma survival. We aimed to compare the performance of commonly used indices for the development of the acute respiratory distress syndrome (ARDS). MATERIALS AND METHODS: Historic, observational cohort study of 27,385 consecutive patients admitted to a statewide referral trauma center between July 11, 2003 and October 31, 2011. A validated algorithm was adapted to identify patients with ARDS. Each trauma index was evaluated in logistic regression using the area under the receiver operating characteristic curve. RESULTS: The case rate for ARDS development was 5.8% (1594). The receiver operating characteristics for injury severity score (ISS) had the best discrimination and had an area under the curve of 0.88 (95% confidence interval [CI] = 0.87-0.89). Glasgow coma score (0.71, 95% CI = 0.70-0.73), A Severity Characterization of Trauma (0.86, 95% CI = 0.85-0.87), Revised Trauma Score (0.71, 95% CI = 0.70-0.72) and thorax Abbreviated Injury Score (0.73, 95% CI = 0.72-0.74) performed worse (P /=16, sensitivity and specificity were 84.9% (95% CI = 83.0%-86.6%) and 75.6% (95% CI = 75.1%-76.2%), respectively. CONCLUSIONS: Among commonly used trauma indices, ISS has superior or equivocal discriminative ability for development of ARDS. A cutoff point of ISS >/=16 provided good sensitivity and specificity. The use of ISS >/=16 is a simple method to evaluate ARDS in trauma epidemiology and outcomes research.
Keywords: Critical Care; trauma; Acute lung injury (ALI); Acute respiratory distress syndrome (ARDS); Glasgow coma score (GCS); Injury severity score (ISS)
Journal Title: The Journal of surgical research
Volume: 201
Issue: 2
ISSN: 1095-8673; 0022-4804
Publisher: Elsevier Inc  
Journal Place: United States
Date Published: 2016
Start Page: 394
End Page: 401
Language: eng
DOI/URL:
Notes: LR: 20160502; CI: Copyright (c) 2016; GR: F32 AA022553/AA/NIAAA NIH HHS/United States; GR: R01 AA018313/AA/NIAAA NIH HHS/United States; JID: 0376340; NIHMS757589; OID: NLM: NIHMS757589 [Available on 04/01/17]; OID: NLM: PMC4852140 [Available on 04/01/17]; OTO: NOTNLM; PMCR: 2017/04/01 00:00; 2015/08/21 [received]; 2015/11/12 [revised]; 2015/11/24 [accepted]; 2015/11/30 [aheadofprint]; ppublish