Bibliographic record
Abstract
Background ARDS is a life-threatening respiratory complication after traumatic spinal cord injury (SCI), yet contemporary, large-scale estimates of its frequency, determinants, and impact on inpatient outcomes are scarce. Research Question Among adults with acute traumatic SCI, what is the incidence of ARDS; which patient, injury, and hospital factors are associated with it; and how does ARDS influence inpatient mortality and adverse events? Study Design and Methods We retrospectively analyzed data from 2010 through 2020 from the Trauma Quality Improvement Program. Adults ≥ 16 years of age with SCI were identified by Abbreviated Injury Scale (AIS) codes. Multivariable logistic regression identified covariates associated with the development of ARDS and quantified the associations of ARDS with mortality and adverse events. Sensitivity analyses excluded patients with AIS code ≥ 3 extraspinal injuries and examined the Berlin criteria era after 2012. Results Of 55,643 SCI admissions, 1,791 patients (3.2%) demonstrated ARDS; yearly incidence fell from 7% to 2% over the study period. Covariates associated with ARDS included COPD (OR, 1.34; 95% CI, 1.08-1.66), diabetes (OR, 1.36; 95% CI, 1.15-1.62), smoking (OR, 1.19; 95% CI, 1.06-1.34), severe thoracic (OR, 1.79; 95% CI, 1.57-2.04) or lower-extremity (OR, 1.23; 95% CI, 1.02-1.48) injury, motor vehicle mechanism (OR, 1.18; 95% CI, 1.03-1.36), and spine surgery (OR, 1.37; 95% CI, 1.21-1.54). Negatively associated factors were Glasgow Coma Scale score of 15 on presentation, incomplete SCI, and thoracic or lumbar levels affected. ARDS was associated with increased mortality (OR, 5.11; 95% CI, 4.37-5.97), ventilator-associated pneumonia (OR, 4.51; 95% CI, 4.00-5.09), sepsis (OR, 6.22; 95% CI, 5.21-7.44), cardiac arrest (OR, 4.02; 95% CI, 3.46-4.68), immobility-related complications (OR, 2.45; 95% CI, 2.18-2.76), and prolonged ICU stay or mechanical ventilation (lasting ≥ 14 days; OR, 5.49; 95% CI, 4.57-6.60). In the subgroup excluding AIS code ≥ 3 extraspinal injuries, ARDS incidence fell to 1.8% with persistently elevated mortality and complication rates. Interpretation Our results show that although ARDS incidence after SCI has declined, it remains linked to adverse in-hospital outcomes. Key associated factors include patient comorbidities and injury-related factors.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".