Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures
Johnson, K.D.; Cadambi, A.; Seibert, G.B.
Journal of Trauma 25(5): 375-384
1985
ISSN/ISBN: 0022-5282 PMID: 3999159 Document Number: 252546
Records of 132 consecutive patients with multiple musculoskeletal injuries were examined to assess the relationship between the length of time from injury to the operative stabilization of major fractures and the incidence of adult respiratory distress syndrome (ARDS). To be included in the study patients had to have had at least 2 major long-bone fractures and a Hospital Trauma Index-Injury Severity Score (ISS) of 18 or higher. Early operative fracture stabilization (STAB) is defined as an operation in the first 24h postinjury at which the majority of fractures were stabilized without leaving a spine, pelvis or femur fracture unstable. A stepwise logistic regression was performed on the data. The dependent variable was the presence or absence of ARDS. The independent variables were age, sex, number of injuries, days to 1st surgery, early operative fracture stabilization (STAB), units of blood the 1st wk, and ISS and its major components: RESP, ABD, CV, EXT, NS and SSQ [respiratory, abdominal, cardiovascular, extremities, nervous and skin and s.c. tissue]. The 2 independent variables selected as significant by this procedure were STAB and ISS. For the overall data set, a delay in orthopedic surgery (greater than 24 h) was associated with a 5-fold increase in the incidence of ARDS (P < 0.001). For the more severely injured patients (ISS > 40), the comparable rates are 17% with early surgery and 75% with delayed surgery (P < 0.001). A Chi-square test for association between ARDS and STAB adjusting for changes due to ISS grouping is significant (P < 0.001). In looking at the individual components of ISS it is seen that NS is the only one significantly associated with ARDS (P = 0.007). There is a significant increase in the incidence of ARDS associated with a delay in operative stabilization of major fractures in patients with multiple orthopedic injuries. This is particularly true for more severely injured patients (ISS > 40). The ISS is of prognostic value in predicting the incidence of ARDS particularly when evaluating EXT and NS injuries in the emergency room.