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10: EARLY PREDICTORS OF MORTALITY IN PEDIATRIC ACUTE RESPIRATORY DISTRESS SYNDROME A PARDIE STUDY

Learning Objectives: The epidemiology of acute respiratory distress syndrome (ARDS) following pediatric trauma is not well described, and no studies have used new pediatric ARDS criteria to assess the incidence, severity, and outcomes of ARDS among critically injured children. Methods: We conducted a retrospective cohort study of all trauma patients ≤17 years old admitted to the intensive care unit at Harborview Medical Center (Washington’s Level 1 pediatric trauma center) or Seattle Children’s Hospital from 2009–2017. We queried electronic health records to identify patients meeting Pediatric Acute Lung Injury Consensus Conference (PALICC) pediatric ARDS (PARDS) oxygenation criteria for ≥6 hours during the first 7 days post-injury and reviewed their charts to determine whether patients met full PALICC PARDS criteria. We estimated associations between PARDS and outcome using generalized linear Poisson regression, adjusted for age, injury mechanism, Injury Severity Score, and brain and chest injuries with Abbreviated Injury Scale severity ≥3. Results: Of 2470 critically injured children, 138 (5.6%) met PALICC PARDS oxygenation criteria, 109 (4.4%) met full PALICC PARDS criteria, 76 (3.1%) met Berlin ARDS criteria, and only 26 (1.1%) had ARDS documented by a physician. Mortality was highest among patients meeting Berlin criteria (39.5%) and lowest among patients with physician documentation of ARDS (30.8%), though the adjusted risk of death was similar across definitions. Of patients meeting full PALICC criteria, the median time to PARDS onset after injury was 1.4 days (IQR 0.9–2.9); trauma was the primary trigger for 87.2% while the remainder developed pneumonia, aspiration, or sepsis prior to PARDS onset. Mortality was 33.0% among PARDS patients vs 1.7% among non-PARDS patients (adjusted RR 4.97, 95% CI 2.87–8.60). Mortality was 46.2% for severe PARDS, 34.4% moderate, and 29.5% mild (aRR 3.06 for severe vs mild, 1.48–6.31). Of patients who survived to hospital discharge, 74.0% of PARDS patients required ongoing post-discharge care vs 11.9% of nonPARDS patients (aRR 1.57, 1.17–2.11). Conclusions: ARDS development following traumatic injury in children is associated with high risk of morbidity and mortality. PALICC criteria identify more trauma patients with ARDS than either Berlin criteria or physician documentation, and may help facilitate earlier implementation of treatment and ultimately prevention strategies. CCMCritical Care MedicineCrit Care Med0090-3493Lippincott Williams & WilkinsHagerstown, MD CCM