Contemporary Patterns of Multiple Organ Dysfunction in Trauma

Shepherd, Joanna; Cole, Elaine; Brohi, Karim

doi:10.1097/shk.0000000000000779

Cited by 63 publications

(50 citation statements)

References 18 publications

(41 reference statements)

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“…SOFA scores were measured daily from admission as described in earlier critical care studies. MODS was defined by the occurrence of a total SOFA score greater than 5, affecting two or more organs. Recovery was deemed to have occurred when the SOFA score fell and remained below 6.…”

Section: Methodsmentioning

confidence: 99%

“…It has been validated for use in injured patients, including its application from the day of admission 16 , and has a good balance of sensitivity and specificity in predicting unfavourable outcome after severe injury 14 . SOFA scores were measured daily from admission as described in earlier critical care studies 16 -18 . MODS was defined by the occurrence of a total SOFA score greater than 5, affecting two or more organs 1,4,19 . Recovery was deemed to have occurred when the SOFA score fell and remained below 6.…”

Section: Definitionsmentioning

confidence: 99%

“…As early‐phase management strategies such as damage control resuscitation have been introduced and more injured patients are surviving to reach critical care, the nature of MODS appears to be changing. Reports of differences in patterns of evolution, severity and outcome are challenging the previously accepted clinical concepts of ‘early and late onset’ or bimodal peaks of MODS. Determining the incidence, pattern and outcomes of MODS in the modern era may help to identify therapeutic opportunities and inform study design for future research.…”

Section: Introductionmentioning

confidence: 99%

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Multiple organ dysfunction after trauma

Cole

Gillespie

Vulliamy

et al. 2020

Journal of British Surgery

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Background The nature of multiple organ dysfunction syndrome (MODS) after traumatic injury is evolving as resuscitation practices advance and more patients survive their injuries to reach critical care. The aim of this study was to characterize contemporary MODS subtypes in trauma critical care at a population level. Methods Adult patients admitted to major trauma centre critical care units were enrolled in this 4‐week point‐prevalence study. MODS was defined by a daily total Sequential Organ Failure Assessment (SOFA) score of more than 5. Hierarchical clustering of SOFA scores over time was used to identify MODS subtypes. Results Some 440 patients were enrolled, of whom 245 (55·7 per cent) developed MODS. MODS carried a high mortality rate (22·0 per cent versus 0·5 per cent in those without MODS; P < 0·001) and 24·0 per cent of deaths occurred within the first 48 h after injury. Three patterns of MODS were identified, all present on admission. Cluster 1 MODS resolved early with a median time to recovery of 4 days and a mortality rate of 14·4 per cent. Cluster 2 had a delayed recovery (median 13 days) and a mortality rate of 35 per cent. Cluster 3 had a prolonged recovery (median 25 days) and high associated mortality rate of 46 per cent. Multivariable analysis revealed distinct clinical associations for each form of MODS; 24‐hour crystalloid administration was associated strongly with cluster 1 (P = 0·009), traumatic brain injury with cluster 2 (P = 0·002) and admission shock severity with cluster 3 (P = 0·003). Conclusion Contemporary MODS has at least three distinct types based on patterns of severity and recovery. Further characterization of MODS subtypes and their underlying pathophysiology may lead to future opportunities for early stratification and targeted interventions.

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Section: Methodsmentioning

confidence: 99%

Section: Definitionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multiple organ dysfunction after trauma

Cole

Gillespie

Vulliamy

et al. 2020

Journal of British Surgery

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“…Abdominal compartment syndrome (ACS) was defined as sustained intra‐abdominal pressure of more than 20 mmHg associated with new organ dysfunction or organ failure. Multiple organ dysfunction syndrome (MODS) as the development of progressive and potentially reversible physiological dysfunction in three or more organs . Infection as a clinically relevant and/or culture positive diagnosis identified by the treating doctor.…”

Section: Methodsmentioning

confidence: 99%

Ten‐year evolution of a massive transfusion protocol in a level 1 trauma centre: have outcomes improved?

Meij

Geeraedts

Kamphuis

et al. 2019

ANZ Journal of Surgery

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BackgroundWe aimed to evaluate the evolution and implementation of the massive transfusion protocol (MTP) in an urban level 1 trauma centre. Most data on this topic comes from trauma centres with high exposure to life‐threatening haemorrhage. This study examines the effect of the introduction of an MTP in an Australian level 1 trauma centre.MethodsA retrospective study of prospectively collected data was performed over a 14‐year period. Three groups of trauma patients, who received more than 10 units of packed red blood cells (PRBC), were compared: a pre‐MTP group (2002–2006), an MTP‐I group (2006–2010) and an MTP‐II group (2010–2016) when the protocol was updated. Key outcomes were mortality, complications and number of blood products transfused.ResultsA total of 168 patients were included: 54 pre‐MTP patients were compared to 47 MTP‐I and 67 MTP‐II patients. In the MTP‐II group, fewer units of PRBC and platelets were administered within the first 24 h: 17 versus 14 (P = 0.01) and 12 versus 8 (P < 0.001), respectively. Less infections were noted in the MTP‐I group: 51.9% versus 31.9% (P = 0.04). No significant differences were found regarding mortality, ventilator days, intensive care unit and total hospital lengths of stay.ConclusionIntroduction of an MTP‐II in our level 1 civilian trauma centre significantly reduced the amount of PRBC and platelets used during damage control resuscitation. Introduction of the MTP did not directly impact survival or the incidence of complications. Nevertheless, this study reflects the complexity of real‐life medical care in a level 1 civilian trauma centre.

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“…MOF was defined as failure (organ score SOFA ≥ 3 points) of at least two of the six listed organs or systems of the SOFA, including respiratory, cardiovascular, renal, hepatic, neurological and hematological (26). MOD was considered when SOFA score was at least six points and prolonged MOD, as MOD lasting over seven days (27). Relative variation of SOFA between the admission and the sixth day, designated by ∆SOFA6, was calculated in accordance to the formula: ∆SOFA6 = (SOFA score at the sixth day/admission SOFA score)×100-100.…”

Section: Methodsmentioning

confidence: 99%