Incidence of acute respiratory distress syndrome in German children and adolescents: a population-based study.

Objective: The objective of this study was to determine the epidemiology of acute respiratory distress syndrome (ARDS) in children and adolescents aged 1 mo to 18 yrs.

Design: The authors conducted a population-based prospective multicenter survey from February 1 to 28,1997, June 1 to 30, 2001, and April 1 to 30, 2004.

Setting: This study was conducted at 94 intensive care units (ICUs) in 1997, 92 ICUs in 2001 and 2004 in the district of Cologne, Germany with a population of 4.15 (1997), 4.28 (2001), and 4.35 million (2004), respectively. The survey was not confined to children's hospitals, but addressed all ICUs.

Patients: This study consisted of children and adolescents aged 1 mo to 18 yrs. Term neonates and premature babies with a corrected age below 43 gestational weeks were excluded. ARDS was defined according to the consensus criteria (acute-onset pulmonary process of noncardiogenic origin, Pao(2)/FIo(2) ratio <200, bilateral alveolar infiltration in chest radiograph).

Results: All ICUs at pediatric hospitals and all but seven adult ICUs collaborated. Incidence of ARDS was assessed as the number of patients entering ARDS criteria within the three study periods divided by the total population in this age group. During the study period, 12 pediatric patients were diagnosed as having ARDS. In five cases, onset was before the study period, representing a calculated prevalence of 5.5 x 10(-5) [3.1 x 10(-5); 9.6 x 10(-5)] cases per year and an incidence of 3. 2 x 10(-5) [1.5 x 10(-5); 6.6 x 10(-5)] cases per year in the age group under investigation.

Conclusion: This is the first population-based evaluation of the incidence of ARDS in the pediatric age group. It shows that the incidence of ARDS in this age group is low. This makes randomized studies on pediatric ARDS aiming on the end point "outcome" nearly impossible.