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[Scoring multiple organ failure after severe trauma. Comparison of the Goris, Marshall and Moore scores]
M Grotz1, M von Griensven, M Stalp
1Unfallchirurgische Klinik, Medizinische Hochschule Hannover. grotz@t-online.de
Introduction:
MOF scores are used to predict, describe and define organ failure. The aim of this study was to compare MOF scoring systems regarding their precision.
Methods:
Data on the ICU course of 301 severely injured patients (PTS > 20, age > 16 years) were documented daily for calculation of three MOF Scores (Goris, Moore, Marshall) for 14 days. Every day the patients were graded by clinical criteria into a group with and a group without MOF by an experienced intensive care physician. The cut-off point for MOF was determined by ROC analysis for each score; the sensitivity and specificity were calculated.
Results:
The patients were 36.3 +/- 1.0 years old, the mean injury severity was 36.2 +/- 0.7 points according to the PTS. Forty-seven (15.6%) of all patients died 17.7 +/- 5.6 days after trauma. The MOF incidence was 26.1%, the MOF mortality 58.4%. The calculated cut-off point for MOF was more than 4 points for the Goris and Marshall scores and more than 3 points for the Moore score. The Moore score is, with sensitivity of 81% and specificity of 88%, superior to the other scores. The Moore score identified 93 patients (30.9%) for MOF; this corresponds with a right answer in 85%. The lower specificity of the Goris and Marshall scores was due to the judgement of liver (GOT) and cardiovascular (PAH) dysfunction respectively.
Conclusion:
For evaluation of MOF after severe trauma the Moore score is superior to other scoring systems (sensitivity 81%; specificity 87%). A score of more than 3 points is associated with MOF. The Moore score did not consider distinct parameters (S-GOT, PAH) which are included in the other systems and were of little importance in our calculations.
Insights
The Moore score is the most precise system for predicting Multiple Organ Failure (MOF) in severely injured patients, offering higher sensitivity and specificity than other MOF scoring systems.
Area of Science:
- Critical Care Medicine
- Trauma Surgery
- Prognostic Scoring Systems
Background:
- Multiple Organ Failure (MOF) scoring systems are crucial for predicting and defining organ failure in critically ill patients.
- Comparing the precision of different MOF scoring systems is essential for accurate clinical assessment.
Purpose of the Study:
- To evaluate and compare the precision of three MOF scoring systems: Goris, Moore, and Marshall.
- To determine the most accurate MOF scoring system for predicting outcomes in severely injured patients.
Main Methods:
- Daily ICU data from 301 severely injured patients were collected for 14 days.
- Three MOF scores (Goris, Moore, Marshall) were calculated, and patients were clinically assessed for MOF daily.
- Receiver Operating Characteristic (ROC) analysis was used to determine MOF cut-off points, sensitivity, and specificity for each score.
Main Results:
- The Moore score demonstrated superior performance with 81% sensitivity and 88% specificity in identifying MOF.
- A Moore score cutoff of >3 points accurately identified MOF in 85% of patients.
- The Goris and Marshall scores had lower specificity due to the inclusion of parameters like liver and cardiovascular dysfunction, which were less impactful in this cohort.
Conclusions:
- The Moore score is the preferred system for evaluating MOF in severe trauma due to its high sensitivity and specificity.
- A Moore score exceeding 3 points reliably indicates the presence of MOF.
- The Moore score's exclusion of certain parameters (S-GOT, PAH) did not compromise its predictive accuracy in this study.
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