Citation

Hutchings L, Watkinson P, Young JD, Willett K. J. Trauma Acute Care Surg. 2016; 82(3): 534-541.

Affiliation

From the University of Oxford (L.H., P.W., J.D.Y., K.W.), Oxford, United Kingdom.

Copyright

(Copyright © 2016, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001328

PMID

28030507

Abstract

BACKGROUND: Postinjury multiple organ failure (MOF) remains a significant cause of morbidity and mortality. A large number of scoring systems have been proposed to define MOF, with no gold-standard. The purpose of this study was to compare three commonly used scores - the Denver PostInjury Multiple Organ Failure Score, the Sequential Organ Failure Assessment (SOFA) and the Marshall Multiple Organ Dysfunction Score - by descriptive analysis of the populations described by each score, and their predictive ability for mortality.

METHODS: An observational cohort study was performed at a UK trauma center on major trauma patients requiring ICU admission from 2003-2011. A novel trauma database was created, merging national audit data with local electronic monitoring systems. Data were collected on demographics, laboratory results, pharmacy, interventions, and hourly physiological monitoring. The primary outcome measure was mortality within 100 days from injury. Sensitivity analyses and receiver operating characteristic (ROC) curves were used to assess the predictive ability of MOF scores for mortality.

RESULTS: In total, 491 patients were included in the trauma database. MOF incidence ranged from 22.8% (Denver) to 40.5% (Marshall) to 58.5% (SOFA). MOF definition did not affect timing of onset, but did alter duration and organ failure patterns. Overall mortality was 10.6%, with Denver MOF associated with the greatest increased risk of death (Hazard Ratio 3.87, 95% CI 2.24-6.66). No significant difference was observed in area under the ROC curve values between scores. Marked differences were seen in relative predictors, with Denver showing highest specificity (81%) and SOFA highest sensitivity (73%) for mortality.

CONCLUSIONS: The choice of MOF scoring system affects incidence, duration, organ dysfunction patterns and mortality prediction. We would recommend use of the Denver score since it is simplest to calculate, identifies a high-risk group of patients and has the strongest association with early trauma mortality. LEVEL OF EVIDENCE: Epidemiological study, Level III.

Language: en