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The incidence and severity of postinjury multiple organ failure (MOF) has decreased over the last decade. Design: A prospective 12-year inception cohort study ending December 31, 2003. Setting: Regional academic level I trauma center. Patients: One thousand three hundred forty-four trauma patients at risk for postinjury MOF. Inclusion criteria were aged older than 15 years, admission to the trauma intensive care unit, an Injury Severity Score higher than 15, and survival for more than 48 hours after injury. Isolated head injuries were excluded from this study. Previously identified risk factors for postinjury MOF were age, Injury Severity Score, and receiving a blood transfusion within 12 hours of injury. Main Outcome Measures: Multiple organ failure was defined by a Denver MOF score of 4 or more for longer than 48 hours after injury. Multiple organ failure severity was defined by the maximum daily MOF score and the number of MOF free days within the first 28 postinjury days. Results: Multiple organ failure was diagnosed in 339 (25%) of 1244 patients. The mean age and Injury Severity Scores increased and the use of blood transfusion during resuscitation decreased over the 12-year study period. After adjusting for age, injury severity, and amount of blood transfused during resuscitation, there was a decreased incidence of MOF over the study period. Of the patients who developed MOF, there was a decrease in disease severity and duration as measured by the maximum daily MOF score and the MOF free days. Although the overall mortality rate remained constant, the MOF-specific mortality decreased. Conclusions: The incidence, severity, and attendant mortality of postinjury MOF decreased over the last 12 years despite an increased MOF risk. Improvements in MOF outcomes can be attributed to improvements in trauma and critical care and are associated with decreased use of blood transfusion during resuscitation.

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Most multiple organ failure (MOF) scores were developed over a decade ago, but little has been done in terms of validation and to understand the differences between populations identified by each of them. Given the lack of a gold standard, validation must rely upon objective clinical and resource utilization outcomes. Thus, we propose to: 1)validate two widely accepted MOF scores (Denver's and Marshall's) examining their association with adverse outcomes in a postinjury population; and 2) compare risk factors, characteristics and outcomes of patients identified by each score. The Denver MOF score grades (from 0-3) 4 organ dysfunctions (lung, kidney, liver, heart) and defines MOF as score > 3. The Marshall score grades, in addition, central nervous system (CNS) and hematologic dysfunction (for a total of 6 organs on a 0 to 4 scale). Using a prospectively collected dataset, MOF scored daily by both scores for 1389 consecutive trauma patients with ISS >15, admitted from 1992-2004, and their outcomes evaluated (death; ventilator-free days, VFD; mechanical ventilation time, MV; and length of stay in the intensive care unit, ICU-LOS). Three major groups could be identified: 1)severe injury group for whom MOF risk factor rates, mortality and utilization were all high (Denver = Marshall= MOF and Denver= MOF + Marshall=No MOF); 2) moderate injury group with medium rate of MOF risk factors, medium utilization and low mortality (Denver= No MOF, Marshall= MOF); and 3) mild injury group for whom risk factor rates, mortality and utilization were all low (Denver = Marshall=No MOF). Both scores performed well, with the Denver MOF score showing greater specificity. The basic concepts of each score can probably be combined to produce an improved MOF score.

Blunt vertebral artery injury is associated with complex cervical spine fractures involving subluxation, extension into the foramen transversarium, or upper C1 to C3 fractures. Routine screening should incorporate these findings to maximize yield while limiting the use of invasive procedures.

Plasma from stored RBCs-even if leukoreduced-delays apoptosis and primes PMNs. The effect becomes evident at 21 days and worsens through product outdate (42 days), but may be prevented by poststorage washing. Inflammatory agents contaminating stored blood likely mediate the effect. Modification of transfusion practices (e.g., giving fresher or washed RBCs or blood substitutes) may attenuate adverse immunomodulatory effects of transfusion in trauma patients.

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