Medical planning for disaster response: Identifying risk factors for developing adult respiratory distress syndrome among trauma patients




ARDS, trauma, humanitarian response, diabetes, smoking


Introduction: Adult respiratory distress syndrome (ARDS) is a well-described complication of critical illness. We hypothesized that rates of comorbid diseases in a population may influence the risk for developing ARDS in trauma patients. This can help plan medical responses.

Methods: Patients from the 2017 National Trauma Databank were analyzed. Inclusion criteria were an injury severity score (ISS) of 2 and 1 or more documented days of mechanical ventilation. Data were analyzed using χ2, Student’s t test, Mann–Whitney U test, or logistic regression as indicated.

Results: Diabetes (odds ratio [OR] 1.33, 95 percent confidence interval [CI] 1.17-1.52), smoking (OR 1.26, 95 percent CI 1.13-1.40), transfusion (OR 1.20, 95 percent CI 1.09-1.32), ISS (OR 1.02, 95 percent CI 1.02-1.03), male gender (OR 1.22, 95 percent CI 1.10-1.35), decreasing Glasgow coma score (OR 1.04, 95 percent CI 1.03-1.05), and increasing abbreviated injury score of the thorax (OR 1.12, 95 percent CI 1.09-1.16) were associated with an increase in risk for developing ARDS.

Conclusion: Diabetes and smoking are risk factors for developing ARDS after trauma. Medical response planning in countries with high rates of diabetes mellitus or smoking should take into account a greater need for intensive care and longer patient admissions to field hospitals.

Author Biographies

Ryan J. Keneally, MD

Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC; Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland

Mark C. Hubbard, MD

Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland

Katrina Hawkins, MD

Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC

Danielle Davison, MD

Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC

Jeffrey S. Berger, MD, MBA, FASA

Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC


Robles A, Kornblith L, Hendrickson C, et al.: Health care utilization and the cost of posttraumatic acute respiratory distress syndrome care. J Trauma Acute Care Surg. 2018; 85(1): 148-154.

Keneally R, Szpisjak D: Thoracic trauma in Iraq and Afghanistan. J Trauma Acute Care Surg. 2013; 74(5): 1292-1297.

Keneally RJ, Shields CH, Hsu A, et al.: Pediatric thoracic trauma in Iraq and Afghanistan. Mil Med. 2018; 183(11-12): e596-e602.

Chan M, Shorr A, Perkins J: Factors associated with acute lung injury in combat casualties receiving massive blood transfusions: A retrospective analysis. J Crit Care. 2012; 27(4): 417-414.

Spinella P, Perkins J, Grathwohl K, et al.: Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries. J Trauma. 2009; 66(4): S69-S76.

Belenkiy S, Buel A, Cannon J, et al.: Acute respiratory distress syndrome in wartime military burns: Application of the Berlin criteria. J Trauma Acute Care Surg. 2014; 76(3): 821–827.

NTDB 2017 Data Dictionary. Available at Accessed December 17, 2019.

Calfee CS, Eisner MD, Ware LB, et al.: Trauma-associated lung injury differs clinically and biologically from acute lung injury due to other clinical disorders. Crit Care Med. 2007; 35(10): 2243-2250.

Robinson BRH, Cohen MJ, Holcomb JB, et al.: Risk factors for the development of acute respiratory distress syndrome following hemorrhage. Shock. 2018; 50(3): 258-264.

Hofman M, Andruszkow H, Kobbe P, et al.: Incidence of posttraumatic pneumonia in poly-traumatized patients: Identifying the role of traumatic brain injury and chest trauma. Eur J Trauma Emerg Surg. 2020; 46(1): 11-19.

Tignanelli CJ, Hemmila MR, Rogers MAM, et al.: Nationwide cohort study of independent risk factors for acute respiratory distress syndrome after trauma. Trauma Surg Acute Care Open. 2019; 4(1): e000249.

Ji M, Chen M, Hong X, et al.: The effect of diabetes on the risk and mortality of acute lung injury/acute respiratory distress syndrome: A meta-analysis. Medicine (Baltimore). 2019; 98(13): e15095.

Boyle AJ, Madotto F, Laffey JG, et al.: Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: An analysis of the LUNG SAFE database. Crit Care. 2018; 22(1): 268.

Bellani G, Laffey JG, Pham T, et al.: Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016; 315(8): 788-800.

Tracy BM, Wilson JM, Staley C, et al.: Metabolic syndrome: Major risk factor for morbidity and mortality in severely injured trauma patients. J Am Coll Surg. 2020; 230(1): 145-150.

Li X, Yu J, Huang W, et al.: Risk factors analysis of acute respiratory distress syndrome in intensive care unit traumatic patients. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018; 30(10): 978-982.

International Diabetes Federation: IDF Diabetes Atlas, 9th ed. Brussels, Belgium: International Diabetes Federation, 2019. Available at Accessed October 8, 2020.

Calfee CS, Matthay MA, Eisner MD, et al.: Active and passive cigarette smoking and acute lung injury after severe blunt trauma. Am J Respir Crit Care Med. 2011; 183(12): 1660-1665.

Moazed F, Hendrickson C, Nelson M, et al.: Platelet aggregation after blunt trauma is associated with the acute respiratory distress syndrome and altered by cigarette smoke exposure. J Trauma Acute Care Surg. 2018; 84(2): 365-371.

Ng M, Freeman MK, Fleming TD, et al.: Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA. 2014; 311(2): 183-192.



How to Cite

Keneally, MD, R. J., M. C. Hubbard, MD, K. Hawkins, MD, D. Davison, MD, and J. S. Berger, MD, MBA, FASA. “Medical Planning for Disaster Response: Identifying Risk Factors for Developing Adult Respiratory Distress Syndrome Among Trauma Patients”. American Journal of Disaster Medicine, vol. 16, no. 1, Jan. 2021, pp. 43-48, doi:10.5055/ajdm.2021.0385.