A Modified Sequential Organ Failure Assessment Score for Critical Care Triage

Grissom, Colin K.; Brown, Samuel M.; Kuttler, Kathryn G.; Boltax, Jonathan; Jones, Jason P.; Jephson, Al; Orme, James F.

doi:10.1001/dmp.2010.40

Cited by 143 publications

(152 citation statements)

References 35 publications

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“…The sepsis-related organ failure assessment score (SOFA) was used to quantify injury severity. Because of the infrequency of bilirubin assays, a modified score that eliminates this value was used with the remaining five parameters [19,20].…”

Section: Patient Management and Data Abstractionmentioning

confidence: 99%

Bacterial Burden in Critically Injured Ventilated Patients Does Not Correlate with Progression to Pneumonia

Dennis

Betzold

Patton

et al. 2018

Surgical Infections

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Background: Ventilator-associated pneumonia (VAP) is common in critically injured patients. The pathogenesis of VAP is not completely understood. We hypothesized that mechanically ventilated trauma patients who develop pneumonia have a progressive increase in pathogen burden over the course of ventilation until a threshold for symptomatic pneumonia is reached, leading to clinical suspicion of VAP. Methods: Critically injured adults ventilated for more than two successive days were enrolled. Patients underwent daily surveillance mini-bronchoscopic alveolar lavage (mBAL) while ventilated for 14 days or until extubation. Standard semi-quantitative cultures were performed, and the investigators were blinded to the results. Standard patient management was performed by the clinical team. Patients suspected of having VAP by the clinical team underwent bronchoscopic bronchoalveolar lavage (bBAL) and semi-quantitative culture, with VAP defined as clinical symptoms plus >10 4 colony-forming units (CFU) of bacteria. Standard statistical analysis for non-parametric data was performed. Results: The 37 patients enrolled were ventilated for a median of nine days. While ventilated, 23 patients met the criteria for a clinical suspicion of VAP, of which two were too ill for bronchoscopy. Thus, 21 patients underwent bBALs because of a suspicion of VAP, and 13 (35%) were positive, with >10 4 CFU of one or more pathogens, and were treated for pneumonia. The bacterial burden on mBAL remained <10 4 CFU during ventilation for 32% of patients. None developed clinical symptoms of VAP. Two-thirds (67%) had an mBAL bacterial burden of >10 4 CFU without clinical suspicion of VAP. Half (56%) of positive surveillance cultures were followed by clinical VAP, confirmed by bBAL, all of which had identical pathogens on mBAL and bBAL. Almost half (44%) of the patients with positive surveillance mBALs never developed clinical VAP. Conclusion: A significant percentage of critically injured, ventilated adults develop high bacterial burdens in the lungs early in their course, and many clear these bacteria without developing VAP. Further study is needed to identify the factors causing progression to VAP.

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Section: Patient Management and Data Abstractionmentioning

confidence: 99%

Bacterial Burden in Critically Injured Ventilated Patients Does Not Correlate with Progression to Pneumonia

Dennis

Betzold

Patton

et al. 2018

Surgical Infections

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“…Various groups have attempted to refine the SOFA score, 6,13–19 but there is no consensus about which elements of the SOFA score are most relevant to mortality. In this study, we evaluated the relative importance of the organ systems measured with the SOFA score in a mixed ICU population with regard to 30-day mortality.…”

Section: Introductionmentioning

confidence: 99%

Glasgow Coma Scale score dominates the association between admission Sequential Organ Failure Assessment score and 30-day mortality in a mixed intensive care unit population

Knox

Lanspa

Pratt

et al. 2014

Journal of Critical Care

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OBJECTIVE The Sequential Organ Failure Assessment (SOFA) score, a measure of multiple organ dysfunction syndrome (MODS), is used to predict mortality in critically ill patients by assigning equally weighted scores across six different organ systems. We hypothesized that specific organ systems would have a greater association with mortality than others. DESIGN We retrospectively studied patients admitted over a period of 4.2 years to a mixedprofile intensive care unit (ICU). We recorded age and comorbidities, and calculated SOFA organ scores. The primary outcome was 30-day all-cause mortality. We determined which organ sub-scores of the SOFA score were most associated with mortality using multiple analytic methods: random forests, conditional inference trees, distanced-based clustering techniques, and logistic regression. SETTING A 24-bed mixed-profile adult ICU that cares for medical, surgical, and trauma (Level 1) patients at an academic referral center. PATIENTS All patients’ first admission to the study ICU during the study period. MEASUREMENTS AND MAIN RESULTS We identified 9,120 first admissions during the study period. Overall 30-day mortality was 12%. Multiple analytical methods all demonstrated that the best initial prediction variables were age and the central nervous system (CNS) SOFA subscore, which is determined solely by Glasgow Coma Scale score. CONCLUSIONS In a mixed population of critically ill patients, the Glasgow Coma Scale score dominates the association between admission SOFA score and 30-day mortality. Future research into outcomes from multiple organ dysfunction may benefit from new models for measuring organ dysfunction with special attention to neurologic dysfunction.

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“…Likewise, dynamic assessment of the SOFA score is superior at predicting 28-day survival/mortality [39][40][41]. Furthermore, modifications of the SOFA score [42][43][44][45][46] have been shown to have good discrimination of development of more severe morbidity.…”

Section: Discussionmentioning

confidence: 99%

The Utility of the Sequential Organ Failure Assessment Score in Predicting Mortality in Critically Ill Obstetric Patients Admitted to a High Dependency Unit in Uganda

Kaye¹

2017

IPCB

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Background: Most maternal deaths result from severe maternal morbidity (SMM with subsequent organ/system dysfunction and organ failure. The objective was to assess the performance of Sequential Organ Failure Assessment (SOFA) score in cases of SMM admitted to the high dependency obstetric unit.Methods: Organ/system dysfunction and failure were assessed according to the maximum score for the six components (respiratory, neurological, renal, hepatic, cardiovascular and coagulation system). The total maximum SOFA score was estimated using the worst result each component on a single day. The distribution of SOFA scores was assessed for normality by using the Shapiro Wilk Test, [p=003]. The mean maximum SOFA scores for each organ/system were computed according to according to outcome (survival or death), using the Mann-Whitney test. The sensitivity, specificity, and the area under the curve (AUC) for each organ/system were evaluated. A Receiver Operator Characteristic (ROC) curve was fitted using maximum likelihood estimates for the total maximum SOFA score, in order to assess the sensitivity, specificity and discriminatory abilities of the maximum SOFA scores. Results:Of the 425 patients with SMM, 345 (81.2%, 95%CI 71.8-82.4) survived while 80 (18.8%, 95% CI: 12.9, 22.6) did not survive. All the non-survivors and 64 (18.5%) of the survivors presented with multiple organ/system dysfunction. Nonsurvivors were more likely to present with more severe and with multiple organ/ system dysfunction. The maximum total SOFA score had good discrimination in the respiratory, cardiovascular and neurological systems, but poor discrimination in the renal, hepatic and coagulatory systems. The total maximum SOFA score displayed an area under the curve (AUC) of 0.83 (95% CI: 0.56, 1.00), with a cutoff value of at least 8.0 sensitivity of 86.7%, and specificity of 90.0%. Conclusion:The total maximum SOFA score showed good predictive and discriminative abilities for maternal mortality in women with severe maternal morbidity.

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A Modified Sequential Organ Failure Assessment Score for Critical Care Triage

Cited by 143 publications

References 35 publications

Bacterial Burden in Critically Injured Ventilated Patients Does Not Correlate with Progression to Pneumonia

Bacterial Burden in Critically Injured Ventilated Patients Does Not Correlate with Progression to Pneumonia

Glasgow Coma Scale score dominates the association between admission Sequential Organ Failure Assessment score and 30-day mortality in a mixed intensive care unit population

The Utility of the Sequential Organ Failure Assessment Score in Predicting Mortality in Critically Ill Obstetric Patients Admitted to a High Dependency Unit in Uganda

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