Article Text

  1. R. J. Freishtat1,2,3,
  2. D. Mathison4,
  3. J. M. Chamberlain1
  1. 1Division of Emergency Medicine, Children's National Medical Center, Washington, DC
  2. 2Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC
  3. 3School of Medicine and Health Sciences, George Washington University, Washington, DC
  4. 4Department of Pediatrics, Northwestern University, Chicago, IL


Purpose Early identification of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is hypothesized to contribute to avoidance of invasive ventilation modalities. There are no studies evaluating ALI in the emergency department (ED), where early identification and interventions are most likely to take place. We aimed to describe the epidemiology of ALI in the ED and to determine factors associated with endotracheal intubation within 24 hours of presentation.

Methods Secondary analyses of 11,664 patient records from a study of quality involving 16 EDs were performed. Records were selected if SaO2 was recorded during the visit. The methods of Ellis and Sevringhaus were used to convert SaO2 to virtual PaO2 and allowed calculation of PaO2:FiO2 (PF) ratios. Combining these and historical data, patients were classified as having ALI alone, ALI and ARDS, or neither according to 1994 American-European Consensus Conference criteria.

Results SaO2 was recorded in 2,217 patients; 108 (4%) met ALI criteria, including 25 (1%) with ARDS. Logistic regression for all patients showed the following independent associations with ALI: lower SaO2 (adjusted OR [95 CI] = 2.4 [2.1, 2.8]), lower temperature (4.1 [2.9,6]), and higher PRISA II (1.13 [1.09, 1.18]) (all p < .001, R2 = .22, goodness of fit p > .99). No association was noted for age, gender, SIRS, shock, pCO2, CNS, renal or hematologic dysfunction. Twelve (11%) ALI patients were intubated within 24 hours of presentation. Logistic regression for ALI patients showed an independent association for intubation with higher PRISA II only (1.21 [1.05, 1.39], p = .007) (R 2 = .26, goodness of fit p = .36).

Conclusions We found a moderate incidence of nonintubated ALI in the ED. The low R 2 values for the ALI and intubation regression models underscore the lack of criteria for early identification of patients with respiratory compromise. Therefore, the nonintubated ALI patients represent an important group for future studies aimed at early identification of critical illness in the ED.

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