ARDS After Spinal Cord Injury

Abstract

Background

ARDS is a life-threatening respiratory complication after traumatic spinal cord injury (SCI), yet contemporary, large-scale estimates of its frequency, determinants, and impact on inpatient outcomes are scarce.

Research Question

Among adults with acute traumatic SCI, what is the incidence of ARDS; which patient, injury, and hospital factors are associated with it; and how does ARDS influence inpatient mortality and adverse events?

Study Design and Methods

We retrospectively analyzed data from 2010 through 2020 from the Trauma Quality Improvement Program. Adults ≥ 16 years of age with SCI were identified by Abbreviated Injury Scale (AIS) codes. Multivariable logistic regression identified covariates associated with the development of ARDS and quantified the associations of ARDS with mortality and adverse events. Sensitivity analyses excluded patients with AIS code ≥ 3 extraspinal injuries and examined the Berlin criteria era after 2012.

Results

Of 55,643 SCI admissions, 1,791 patients (3.2%) demonstrated ARDS; yearly incidence fell from 7% to 2% over the study period. Covariates associated with ARDS included COPD (OR, 1.34; 95% CI, 1.08-1.66), diabetes (OR, 1.36; 95% CI, 1.15-1.62), smoking (OR, 1.19; 95% CI, 1.06-1.34), severe thoracic (OR, 1.79; 95% CI, 1.57-2.04) or lower-extremity (OR, 1.23; 95% CI, 1.02-1.48) injury, motor vehicle mechanism (OR, 1.18; 95% CI, 1.03-1.36), and spine surgery (OR, 1.37; 95% CI, 1.21-1.54). Negatively associated factors were Glasgow Coma Scale score of 15 on presentation, incomplete SCI, and thoracic or lumbar levels affected. ARDS was associated with increased mortality (OR, 5.11; 95% CI, 4.37-5.97), ventilator-associated pneumonia (OR, 4.51; 95% CI, 4.00-5.09), sepsis (OR, 6.22; 95% CI, 5.21-7.44), cardiac arrest (OR, 4.02; 95% CI, 3.46-4.68), immobility-related complications (OR, 2.45; 95% CI, 2.18-2.76), and prolonged ICU stay or mechanical ventilation (lasting ≥ 14 days; OR, 5.49; 95% CI, 4.57-6.60). In the subgroup excluding AIS code ≥ 3 extraspinal injuries, ARDS incidence fell to 1.8% with persistently elevated mortality and complication rates.

Interpretation

Our results show that although ARDS incidence after SCI has declined, it remains linked to adverse in-hospital outcomes. Key associated factors include patient comorbidities and injury-related factors.