Pattern of Organ Failure following Severe Trauma

Abstract

Multiple organ failure (MOF) is considered to be the leading cause of death after severe trauma. Although there is extensive literature on MOF, little is known about the pattern, sequence, and onset of this clinical syndrome. The first goal of this clinical study was to define MOF; the second was to assess the typical onset, sequence, and pattern of MOF; and the third was to define certain risk factors for the development of MOF in 342 multiple trauma patients. Patients with an Injury Severity Score (ISS): > 20 (mean 35.7) were included. Three well established MOF scoring methods were used to give strict definitions of MOF: 11.4% of the total patient population developed MOF, and 88.6% did not. Respiratory failure was most frequent in patients developing MOF (74.4%), and these patients had the highest mortality rate (65.5%) compared to patients with failure of other organ systems (liver, cardiovascular system). Generally, the lung is the first organ to fail after injury (failure after 3.7 +/- 2.8 days). Significant renal failure and the need for dialysis decreased to < 5%; other signs of organ dysfunction (gastric, central nervous system) are difficult to verify. Typical risk factors for the development of MOF after severe trauma are the severity, type, and distribution of injury as well as the indicators of prolonged hemorrhagic shock (elevated lactate levels). The main therapeutic efforts, therefore, should be the effective treatment of traumatic hemorrhagic shock during the initial phase, adequate resuscitation, optimal oxygenation, and early surgical treatment.

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

“…In spite of this, our findings are in agreement with previous research that SOFA scores have good discrimination between survivors and nonsurvivors [32]. In addition, as in prior research [33][34][35][36], multiple organ dysfunction evidenced by high SOFA scores are associated with higher mortality. The use of proxy variables for SOFA scores has been validated in prior research.…”

A Multi-Center Evaluation of Early Acute Kidney Injury in Critically Ill Trauma Patients

“…[3,41] Prior clinical studies have suggested the majority of AKI in trauma develops late and generally as a complication of septic shock and/or progressive multiple organ dysfunction syndrome. [23][24][25]42] Alternatively, our study is strengthened by being the largest multi-center study of AKI in trauma performed to date. We contend our data provides a crude descriptive analysis of the occurrence of early AKI, defined by the RIFLE criteria, that is more likely to be attributable to trauma rather than to delayed or additional confounding factors (i.e.…”

Predictive modelling of survival and length of stay in critically ill patients using sequential organ failure scores

“…The score can measure individual or aggregate organ dysfunction over time and is useful to evaluate morbidity. Although the SOFA scoring was not developed to predict outcome, the obvious relationship between organ dysfunction and mortality has been demonstrated in several studies [3,6,7].…”