Article Text

Toward Early Identification of Acute Lung Injury in the Emergency Department
  1. Robert J. Freishtat,
  2. Bahar Mojgani,
  3. David J. Mathison,
  4. James M. Chamberlain
  1. From the Division of Emergency Medicine (R.J.F., J.M.C.), Children's National Medical Center, Washington, DC; Research Center for Genetic Medicine (R.J.F.), Children's Research Institute, Children's National Medical Center, Washington, DC; Department of Pediatrics (R.J.F., J.M.C.), The George Washington University School of Medicine and Health Sciences, Washington, DC; Georgetown University School of Medicine (B.M.), Washington, DC; and Children's Memorial Hospital (D.J.M.), Department of Pediatrics, Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL.
  1. Supported by National Institutes of Health grant K23-RR-020069 (to R.J.F.).
  2. Presented in part at the Pediatric Academic Societies' Annual Meeting in San Francisco, CA, May 1, 2006.
  3. Address correspondence to: Dr. Robert J. Freishtat, Division of Emergency Medicine, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010; e-mail: rfreishtat{at}


Background There are no studies evaluating the epidemiology of pediatric acute lung injury (ALI) in the emergency department (ED), where early identification and interventions are most likely to be helpful. The purpose of this study was to describe the epidemiology of the ALI precursor acute hypoxemic respiratory failure (AHRF) in the ED.

Methods We analyzed 11,664 pediatric patient records from 16 EDs. Records were selected if oxygen saturation (SpO2) was recorded during the visit. Virtual partial pressure of oxygen (pO2) was calculated from SpO2, thus allowing calculation of ratios of pO2 to fraction of inspired oxygen (FiO2) (PFRs). Patients with a PFR < 300 were classified as having AHRF. Univariate analyses and logistic regression were used to test the association of clinical factors with the presence of AHRF and intubation.

Results AHRF criteria (ie, PFR < 300) were met in 121 (2.9%) of the 4,184 patients with an oxygenation measurement. The following variables were independently associated with ALI: higher Pediatric Risk of Admission II score (adjusted odds ratio [95% confidence interval (CI)] = 1.12 [1.08-1.16]; p < .001), higher heart rate (1.02 [1.01-1.03]; p = .009), a positive chest radiograph (2.35 [1.02-5.43]; p = .045), and lower temperature (0.49 [0.36-0.68]; p < .001). The final model had an R2 = .20.

Conclusion We found nonintubated AHRF to be prevalent in the ED. The low R2 for the regression model for AHRF underscores the lack of criteria for early identification of patients with respiratory compromise. Our findings represent an important first step toward establishing the true incidence of ALI in the pediatric ED.

Key words
  • respiratory distress syndrome (adult)
  • severity of illness index
  • oximetry

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