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Open Access Original Research

Towards prevention of acute lung injury: frequency and outcomes of emergency department patients at-risk – a multicenter cohort study

Peter C Hou115234*, Marie-Carmelle Elie-Turenne56, Aya Mitani1637, Jonathan M Barry1723, Erica Y Kao1183, Jason E Cohen1989, Gyorgy Frendl20347, Ognjen Gajic10111221, Nina T Gentile131422 and On Behalf of US Critical Illness and Injury Trials Group: Lung Injury Prevention Study Investigators (USCIITG–LIPS 1)

Author Affiliations

1 Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA

2 Division of Burn, Trauma, and Surgical Critical Care, Brigham and Women’s Hospital, Boston, MA, USA

3 Surgical Intensive Care Unit Translational Research (STAR) Center, Brigham and Women’s Hospital, Boston, MA, USA

4 Harvard Medical School, Boston, MA, USA

5 Department of Emergency Medicine, University of Florida College of Medicine, 1329 SW 16th Street, Gainesville FL 32610, USA

6 Emergency Department, Shands University of Florida, Medical Center, Gainesville, FL, USA

7 Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA

8 Department of Emergency Medicine, Albany Medical Center, Albany, NY, USA

9 Albany Medical College, Albany, NY, USA

10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA

11 Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, USA

12 Mayo Medical School, Rochester, MA, USA

13 Department of Emergency Medicine, Temple University Hospital, Philadelphia, PA, USA

14 Temple University School of Medicine, Philadelphia, PA, USA

15 Harvard Medical School, Department of Emergency Medicine & Division of Burn, Trauma, and Surgical Critical Care, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Neville House 312-B, Boston, MA 02115, USA

16 Department of Medicine, Stanford Hospitals and Clinics, 300 Pasteur Drive, Room: S102, MC: 5110, Stanford, CA 94305, USA

17 Division of Burn, Trauma, and Surgical Critical Care, Brigham and Women’s Hospital, 75 Francis Street, Boston, \ 02115, USA

18 Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA

19 Albany Medical Center Emergency Medicine Group, 47 New Scotland Avenue, MC 139, Albany, NY 12208, USA

20 Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA

21 Pulmonary and Critical Care Medicine, Mayo Clinic, Old Marian Hall, Second Floor, Room 115, 200 First St. SW, Rochester, MN 5590, USA

22 Department of Emergency Medicine, Temple University Hospital, Administrative Office, 10th Floor, Jones Hall, 1316 W. Ontario Street, Philadelphia, PA 19140, USA

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International Journal of Emergency Medicine 2012, 5:22  doi:10.1186/1865-1380-5-22

Published: 27 May 2012

Abstract

Background

Few emergency department (ED) evaluations on acute lung injury (ALI) have been carried out; hence, we sought to describe a cohort of hospitalized ED patients at risk for ALI development.

Methods

Patients presenting to the ED with at least one predisposing condition to ALI were included in this study, a subgroup analysis of a multicenter observational cohort study (USCIITG-LIPS 1). Patients who met ALI criteria within 6 h of initial ED assessment, received end-of-life care, or were readmitted during the study period were excluded. Primary outcome was frequency of ALI development; secondary outcomes were ICU and hospital mortality.

Results

Twenty-two hospitals enrolled 4,361 patients who were followed from the ED to hospital discharge. ALI developed in 303 (7.0 %) patients at a median onset of 2 days (IQR 2–5). Of the predisposing conditions, frequency of ALI development was highest in patients who had aortic surgery (43 %) and lowest in patients with pancreatitis (2.8 %). Compared to patients who did not develop ALI, those who did had higher ICU (24 % vs. 3.0 %, p < 0.001) and hospital (28 % vs. 4.6 %, p < 0.001) mortality, and longer hospital length of stay (16 vs. 5 days, p < 0.001). Among the 22 study sites, frequency of ALI development varied from less than 1 % to more than 12 % after adjustment for APACHE II.

Conclusions

Seven percent of hospitalized ED patients with at least one predisposing condition developed ALI. The frequency of ALI development varied significantly according to predisposing conditions and across institutions. Further research is warranted to determine the factors contributing to ALI development.