Validation of Postinjury Multiple Organ Failure Scores

Abstract

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.

How to Avoid Nontherapeutic Laparotomy in Patients With Multiple Organ Failure of Unknown Origin. The Role of CT Scan Revisited

“…12 Moreover, nontherapeutic laparotomy has been associated with a morbidity rate up to 22%, 3 may aggravate patients' conditions, and may delay further evaluation. In the difficult clinical scenario of suspected intra-abdominal sepsis systematic CT scan may increase the physician's level of diagnostic certainty, rule out significant disorders by associating chest or other organ focused CT scan to the abdomino-pelvic scan, and provide an alternative diagnosis.…”

Large-magnitude Pelvic and Retroperitoneal Tissue Damage Predicts Organ Failure

“…Although clinicians have rightfully focused on correspondence among head, chest, and abdominal injury with MOF, few studies have evaluated the impact and severity of pelvic trauma on the development of MOF [16,23]. ISS has long been used as a surrogate of mechanical injury; however, it has been shown to consistently underestimate mechanical injury [4,25].…”

“…Both outcome instruments have been validated in a trauma population [1,9,23]. MOF was described as a score of C 4 with involvement of at least two organ systems for the Denver score [23,24]. The SOFA score evaluates the following six organ systems with an increasing score of dysfunction from 0 to 4: cardiovascular, respiratory, hepatic, renal, hematologic, and neurologic; the Denver MOF score evaluates the following four organ systems with an increasing score of dysfunction from 0 to 3: cardiac, pulmonary, hepatic, and renal ( Table 1).…”

“…Both outcome instruments have been validated in a trauma population [1,9,23]. MOF was described as a score of C 4 with involvement of at least two organ systems for the Denver score [23,24].…”

Multiple Organ Dysfunction Syndrome (MODS): Is It Preventable or Inevitable?

“…These criteria should include reliability, validity and the ability of a scoring system to unmask temporal changes in organ dysfunction if measured sequentially [18,19]. Studies evaluated the comparative prognostic value of the commonly used organ dysfunction scoring systems concluded that some standardization of the included variables is needed before introducing a scoring tool in everyday practice [20,21]. In the absence of a gold standard scoring or tool for diagnosis or prediction of MODS, validation is required to evaluate the association of different scores with objective, adverse outcomes, clinical status and resource utilization.…”