Incidence of acute lung injury in the United States
Incidence of acute lung injury in the United States
复制标题
DOI：
10.1097/01.ccm.0000063475.65751.1d
复制
发表时间：
2003-06-01
影响因子：
8.8
通讯作者：
Rubenfeld, GD
中科院分区：
文献类型：
--
作者：
Goss, CH;Brower, RG;Rubenfeld, GD
目的：最近估计的急性呼吸窘迫综合征（ARDS）发病率为1.3 - 22例/10万人年（10（5）人年）;急性肺损伤（ALI）发病率为17.9 - 34例/10（5）人年。造成这种广泛差异的可能原因包括综合征定义的差异、抽样人群的差异以及估计发病率的假设。我们假设，仔细的，前瞻性的，协议驱动的情况下识别，包括轻度低氧血症标准的急性肺损伤将产生发病率数字大于先前reported.Design：前瞻性队列研究与外推到美国人口。国家心肺血液研究所赞助的由20家医院组成的ARDS网络。作为美国国立卫生研究院赞助的ARDS网络的一部分，20家医院前瞻性地确定了1996年至1999年的ALI患者。本研究的筛选日志用于估计重症监护病房（ICU）病床每年的ALI发生率。我们使用美国医院协会的登记和数据来估计美国ALI的发病率。无。测量和主要结果。在ARDS网络登记中，每个ICU床位的ALI发生率从每年每个ICU床位0.7例到5.8例不等，平均每年每个ICU床位2.2例。我们通过进行各种敏感性分析来测试发病率估计的稳健性。当我们使用保守的假设，即每个参与医院的ARDS网络筛查日志都是完整的，并且ALI病例仅限于拥有大于或等于20张成人ICU床位的学术医院时，美国成人ALI的发病率为22.4例/10（5）人-年。在不太保守的假设下，即ALI病例仅发生在ICU床位大于或等于20张的医院，无论其学术状况如何，美国ALI的发病率估计为64.2例/10（5）人-年。基于这项分析，使用了前瞻性临床试验筛选数据和关于ALI患者在哪里接受治疗的保守假设，在美国ALI的发病率似乎比以前报道的要高。
Objective: Recent estimates of acute respiratory distress syndrome (ARDS) incidence have varied from 1.3 to 22 per 100,000 person years (10(5) person-years); the incidence of acute lung injury (ALI) has varied from 17.9 to 34 cases per 10(5) person-years. Potential reasons for this wide range include differences in the definition of the syndrome, in the populations sampled, and in the assumptions made to estimate incidence. We hypothesized that careful, prospective, protocol-driven case identification that included the milder hypoxemia criterion for ALI would yield incidence numbers greater than previously reported.Design: Prospective cohort study with extrapolation to the U.S. population.Setting. National Heart, Lung, and Blood Institute-sponsored ARDS Network composed of 20 hospitals.Patients. As part of the National Institutes of Health-sponsored ARDS network, 20 hospitals prospectively identified patients with ALI from 1996 to 1999. Screening logs from this study were used to estimate ALI rates per intensive care unit (ICU) bed per year. We used the registry and data from the American Hospital Association to estimate the incidence of ALI in the United States.Interventions. None.Measurements and Main Results. The ALI per ICU bed incidence in the ARDS network registry varied from 0.7 to 5.8 cases of ALI per ICU bed per year with an average of 2.2 cases of ALI per ICU bed per year. We tested the robustness of the incidence estimate by performing a variety of sensitivity analyses. When we used the conservative assumptions that the ARDS network screening logs were complete at each of the participating hospitals and that ALI cases are limited to academic hospitals with greater than or equal to20 adult ICU beds, the incidence of ALI in adults in the United States is 22.4 cases per 10(5) person-years. Under the less conservative assumption that ALI cases occurred only at hospitals with greater than or equal to20 ICU beds, regardless of their academic status, the incidence of ALI in the United States is estimated at 64.2 cases per 10(5) person-years.Conclusions: Based on this analysis, which used prospective clinical trial screening data and conservative assumptions about where patients with ALI are cared for, the incidence of ALI in the United States appears to be higher than previously reported.