Epidemiology, outcomes, and factors associated with mortality in pediatric acute respiratory distress syndrome in hospitalized Thai children: a nationwide retrospective analysis, 2015-2022.
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BACKGROUND: Pediatric acute respiratory distress syndrome (PARDS) causes significant morbidity and mortality, especially in resource-limited settings. This study assessed national hospital and PICU admission rates, regional disparities, and factors associated with mortality in Thai children with PARDS. METHODS: A nationwide retrospective study was conducted using National Health Security Office (NHSO) data from 2015 to 2022. Children aged 1 month to < 18 years with a diagnosis of PARDS (ICD-10-TM code J80) were included. Multivariable logistic regression was used to identify factors associated with mortality, reported as adjusted relative risk (ARR) with 95% confidence intervals (CI). RESULTS: Among 4,241 patients, the prevalence of PARDS ranged from 29.8 to 37.2 per 100,000 hospital admissions, while PICU admission rates ranged from 13.5 to 18.6 per 1,000. Bangkok had the highest rate in 2022 (27.0 per 1,000) but the lowest mortality at 25.6%. The overall mortality rate declined from 53.7% in 2015 to 37.7% in 2022 but remained high in resource-limited regions. Malignancy (ARR 1.29, 95% CI 1.17-1.43 p < 0.001), drowning (ARR 1.43, 95% CI 1.29-1.60, p < 0.001), sepsis and septic shock (ARR 1.19, 95% CI 1.12-1.27, p < 0.001), non-major pulmonary trauma (ARR 1.43, 95% CI 1.16-1.77, p = 0.001), and cardiovascular dysfunction (ARR 1.41, 95% CI 1.32-1.51, p < 0.001) were strongly associated with mortality. Intubation was significantly associated with increased mortality (ARR 2.52, 95% CI 2.12-3.00, p < 0.001), whereas extracorporeal life support was associated with lower mortality (ARR 0.46, 95% CI 0.35-0.61, p < 0.001). CONCLUSIONS: PARDS remains a substantial burden in Thailand, with marked regional differences in access to critical care. Efforts to strengthen healthcare infrastructure and early respiratory support are needed to reduce preventable deaths.