Prevention and early intervention continue to be aggressively pursued in the management of ARDS. The objectives of this study were to: (1) determine if the identification and diagnosis of ARDS at one hospital has been accurate and timely, (2) identify possible trends in laboratory and radiological data during the 48 hours prior to the onset of ARDS (time of fulfillment of operational definitions of ARDS), and (3) improve the future identification of at-risk patients.
Data Sources/Study Selection
Data were obtained through a retrospective chart review of Legacy Emmanuel Hospital's (LEH) Trauma Department patient records from 1996 through 1999. All patients with the medical record index diagnosis of ARDS were included in the study, regardless of age. The study sample was drawn from a total of 7,254-traumas patients admitted to LEH. 17 were identified to have developed ARDS. The patient charts were identified using the Trauma Department Registry Department. Staffs at LEH's Trauma Department Registry identify ARDS patietns by reviewing the discharge summaries of Trauma Department patients. Discharge summaries are written by Trauma Nurse Clinicians, who prospectively gather information every other day during the patient's hospital stay. This information is used to create a discharge summary. It is important to note that all physician entries in the chart that comment on the health status of the patient may be included in the discharge summary, if deemed significant. In the case of ARDS, the Trauma Team did not always make the diagnosis of ARDS. Registry personnel may also draw a diagnosis from a radiologist's report in the interpretation of a chest x-ray. The Trauma Department Registry assumes such diagnoses are correct.
(1)The identification and diagnosis of ARDS patients at Legacy Emmanuel Hospital was not always timely, but was fairly accurate. According to criteria fulfillment of ARDS by chart review, 15 out of the 16 subjects were diagnosed late an average of 50 hours, and one was diagnosed early by 86 hours. According to chart review confirmation, 13 out of 16 subjects were accurately diagnosed with ARDS.
(2) Trends in laboratory data were observed and some were found to be potentially helpful for early identification. Those include chest x-ray, P:F ratio, PCWP, PaO2); blood pressure (particularly diastolic), WBC count, and fluid balance.
(3) Methods for improving the future identification of at-risk patients include: frequent (at least daily) blood gas analysis, especially patients on mechanical ventilation; aggressive monitoring once chest x-ray is positive for bilateral infiltrates; closer inspection of ISS score area of injury, particularly with injuries to the chest; and increased communication between the different specialties caring for the at-risk patient.
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