
==== Front
Plast Reconstr Surg Glob Open
Plast Reconstr Surg Glob Open
GOX
Plastic and Reconstructive Surgery Global Open
2169-7574
Lippincott Williams & Wilkins Hagerstown, MD

GOX-D-24-00774
00032
10.1097/01.GOX.0001063936.55635.c0
3
PSTM Abstract Supplement
PSTM Top Abstracts/Posters 2024
Risk Factors and In-Hospital Outcomes of Acute Respiratory Distress Syndrome (ARDS) in Burn Patients: An Analysis of the National Trauma Data Bank (NTDB)
Sim Danielle BA 1
Subramanian Madhu MD 1
Caffrey Julie DO, MS 1
Johns Hopkins University School of Medicine
9 2024
18 9 2024
12 Suppl 24-25Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

OPEN-ACCESSTRUE
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pmcPURPOSE: Acute Respiratory Distress Syndrome (ARDS) is a common complication among mechanically ventilated adult burn patients; however, the risk factors associated with its development are not well understood. Acute kidney injury and burn severity may predict ARDS, while the role of inhalation injury is still debated. Conflicting evidence exists regarding ARDS as an independent predictor of poor hospital outcomes. Given that prior studies are limited by small sample size or single institutional data, the purpose of this study is to identify risk factors for ARDS in mechanically ventilated adult burn patients and characterize the impact of ARDS on hospital course using multi-institutional data.

METHODS: The National Trauma Data Bank (NTDB) was queried for patients ≥18 years with ICD-9 or ICD-10 codes corresponding to burn injury from 2007-2016. Hospitalized patients with at least 48 hours of mechanical ventilation were included. Demographics, medical comorbidities, total body surface area (TBSA), injury severity score (ISS), initial Emergency Department (ED) vital signs, length of stay, and in-hospital mortality were collected. Chi-squared test, Wilcoxon rank sum test, unpaired t-test, and univariate and multivariate logistic regression were used to identify risk factors for ARDS. Propensity score matched analysis at a 1:5 ratio was used to determine the impact of ARDS on hospital course.

RESULTS: This sample included 13928 patients, of which 1437 (10.3%) developed ARDS. The average age for ARDS patients was 50 (standard deviation [SD]:17) which was older than non-ARDS patients (48 [SD:18], p<0.001). The median (interquartile range [IQR]) ISS for ARDS patients was also greater than non-ARDS patients (18 [9-26] vs. 10 [4-25], p<0.001). ARDS patients had a higher incidence of inhalation injury (198 [14%] vs. 1188 [10%], p<0.001) and burns covering more than 20% TBSA (464 [32%] vs. 2986 [24%], p<0.001) compared with the non-ARDS cohort. On multivariate logistic regression after controlling for age and sex, hypotension in the ED (adjusted odds ratio [aOR]: 1.83, 95% confidence interval [CI]: 1.29-2.54, p<0.001), alcohol use disorder (aOR: 1.82, 95%CI: 1.39-2.36, p<0.001), and inhalation injury (aOR: 1.57, 95%CI: 1.04-2.29, p=0.026) were most strongly associated with ARDS. TBSA and ISS also increased the risk of developing ARDS (aOR:1.07, 95% CI:1.02-1.12, p=0,007; aOR:1.02, 95% CI: 1.02-1.03, p<0.001). After propensity score matching controlling for age, ISS, TBSA, inhalation injury, alcohol use disorder, and admission year, ARDS patients had a significantly longer median (IQR) length of stay (32 [15-53] vs. 22 [7-33], p<0.001). In-hospital mortality was also significantly higher in the ARDS cohort (295 [37%] vs. 668 [25%], p<0.001).

CONCLUSION: This study confirms that both TBSA and inhalation injury are associated with ARDS development. Injury severity, hypotension in the ED, and alcohol use disorder were identified as novel risk factors for ARDS after burns. Furthermore, ARDS is independently associated with worse hospital outcomes including length of stay and mortality. These findings highlight the impact of patient and injury characteristics on developing ARDS and support the consideration of ARDS when estimating mortality risk in burn patients.
