Citation

Ting RS, Lewis DP, Yang KX, Nguyen TA, Sarrami P, Daniel L, Hourigan S, King K, Lassen C, Sarrami M, Ridley W, Alkhouri H, Dinh M, Balogh ZJ. J. Trauma Acute Care Surg. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000003923

PMID

36809374

Abstract

BACKGROUND: Postinjury multiple organ failure (MOF) is the leading cause of late death in trauma patients. Although MOF was first described 50 years ago, its definition, epidemiology and change in incidence over time are poorly understood. We aimed to describe the incidence of MOF in the context of different MOF definitions, study inclusion criteria, and its change over time.

METHODS: Cochrane Library, EMBASE, MEDLINE, PubMed and Web of Science databases were searched for articles published between 1977-2022 in English and German. Random effects meta-analysis was performed when applicable.

RESULTS: The search returned 11440 results, of which 842 full-text articles were screened. MOF incidence was reported in 284 studies that used 11 unique inclusion criteria and 40 MOF definitions. 108 studies published from 1992-2018 were included. Weighted MOF incidence by publication year fluctuated from 11%-56% without significant decrease over time. MOF was defined using four scoring systems (Denver, Goris, Marshall, SOFA) and 12 different cut-off values. Overall, 353718 trauma patients were included, of whom 83766 (24%) developed MOF. The weighted incidences of MOF from meta-analysis of 30 eligible studies were: 14.7% (95% CI:12.1%-17.2%) in Denver>3, 12.7% (95% CI:9.3-16.1%) in Denver>3 with blunt injuries only, 28.6% (95% CI:12%-45.1%) in Denver>8, 25.6% (95% CI:10.4%-40.7%) in Goris>4, 29.9% (95% CI:14.9%-45%) in Marshall>5, 20.3% (95% CI:9.4%-31.2%) in Marshall>5 with blunt injuries only, 39.2% (95% CI:33.7%-44.7%) in SOFA>3, 47.3% (95% CI:29.1%-65.5%) in SOFA>4, 55.6% (95% CI:49.1%-62.2%) in SOFA>4 with blunt injuries only, 51.6% (95% CI:45.5%-57.7%) in SOFA>6.

CONCLUSIONS: The incidence of postinjury MOF varies largely due to lack of a consensus definition and study population. Until a consensus is reached, further research will be hindered. LEVEL OF EVIDENCE: Level III, Systematic Review and Meta-Analysis.

Language: en