Impact of acute lung injury and acute respiratory distress syndrome after traumatic brain injury in the United States

Neurosurgery. 2012 Oct;71(4):795-803. doi: 10.1227/NEU.0b013e3182672ae5.


Background: Traumatic brain injury (TBI) is a major cause of disability, morbidity, and mortality. The effect of the acute respiratory distress syndrome and acute lung injury (ARDS/ALI) on in-hospital mortality after TBI remains controversial.

Objective: To determine the epidemiology of ARDS/ALI, the prevalence of risk factors, and impact on in-hospital mortality after TBI in the United States.

Methods: Retrospective cohort study of admissions of adult patients>18 years with a diagnosis of TBI and ARDS/ALI from 1988 to 2008 identified through the Nationwide Inpatient Sample.

Results: During the 20-year study period, the prevalence of ARDS/ALI increased from 2% (95% confidence interval [CI], 2.1%-2.4%) in 1988 to 22% (95% CI, 21%-22%) in 2008 (P<.001). ARDS/ALI was more common in younger age; males; white race; later year of admission; in conjunction with comorbidities such as congestive heart failure, hypertension, chronic obstructive pulmonary disease, chronic renal and liver failure, sepsis, multiorgan dysfunction; and nonrural, medium/large hospitals, located in the Midwest, South, and West continental US location. Mortality after TBI decreased from 13% (95% CI, 12%-14%) in 1988 to 9% (95% CI, 9%-10%) in 2008 (P<.001). ARDS/ALI-related mortality after TBI decreased from 33% (95% CI, 33%-34%) in 1988 to 28% (95% CI, 28%-29%) in 2008 (P<.001). Predictors of in-hospital mortality after TBI were older age, male sex, white race, cancer, chronic kidney disease, hypertension, chronic liver disease, congestive heart failure, ARDS/ALI, and organ dysfunctions.

Conclusion: Our analysis demonstrates that ARDS/ALI is common after TBI. Despite an overall reduction of in-hospital mortality, ARDS/ALI carries a higher risk of in-hospital death after TBI.

MeSH terms

  • Acute Lung Injury / epidemiology*
  • Acute Lung Injury / etiology*
  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Injuries / complications*
  • Brain Injuries / epidemiology*
  • Brain Injuries / mortality
  • Chi-Square Distribution
  • Cohort Studies
  • Confidence Intervals
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • International Classification of Diseases
  • Length of Stay
  • Male
  • Middle Aged
  • Radiography
  • Respiratory Distress Syndrome, Adult / epidemiology*
  • Respiratory Distress Syndrome, Adult / etiology*
  • Retrospective Studies
  • Risk Factors
  • United States / epidemiology
  • X-Rays