Incidence and Mortality of Acute Respiratory Distress Syndrome in Children: A Systematic Review and Meta-Analysis

Objectives: Our understanding of the acute respiratory distress syndrome in children is limited, and literature is dominated by investigations in adult patients. Recent preclinical studies suggest that the susceptibility to and severity of acute respiratory distress syndrome in children could differ from that in adults. We assessed the incidence and mortality of acute respiratory distress syndrome reported in children in studies published in the last two decades. Data Sources: Medline, Embase, and CINAHL databases were searched up to August 2014. Study Selection: Articles reporting study data on population- or PICU-based incidence and mortality of acute respiratory distress syndrome in children (> 36 wk gestation and < 18 yr old) were selected. Data Extraction: Two authors independently collected data and assessed methodological quality and risk of bias of selected studies. Pooled estimates of incidence and mortality were calculated using random-effects models. To explore heterogeneity, influence of study characteristics, including median year of conduct, study location, inclusion and exclusion criteria, and study design and quality, was assessed by meta-regression analysis. Data Synthesis: Twenty-nine studies reported on incidence and 32 on mortality. Pooled weighted estimate of the population-based and PICU-based incidence of pediatric acute respiratory distress syndrome was 3.5 (95% CI, 2.2-5.7) cases per 100,000 person years and 2.3% (95% CI, 1.9-2.9), respectively. Pooled weighted mortality was 33.7% (95% CI, 28.6-39.7). There were no trends over time, but mortality was significantly associated with study location. Conclusions: This systematic review and meta-analysis shows a low incidence but a high mortality. Its results also indicate that both incidence and mortality of pediatric acute respiratory distress syndrome have not changed over the last two decades and that mortality depends on the geographic location of studies.