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Multiple organ failure in trauma patients.

Rodney M Durham1, J J Moran, John E Mazuski

  • 1University of South Florida, Tampa, Florida 33601, USA. rdurham@hsc.usf.edu

The Journal of Trauma
|October 21, 2003
PubMed
Summary

Organ failure incidence in critically ill trauma patients is lower than previously reported. While single organ failure has low mortality, multiple organ failure remains highly lethal.

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Area of Science:

  • Critical Care Medicine
  • Trauma Surgery
  • Epidemiology of Organ Failure

Background:

  • Improvements in critical care and evolving organ failure definitions suggest decreasing incidence and mortality.
  • Previous studies often included heterogeneous medical and surgical populations, potentially skewing organ failure rates.
  • A need exists to reassess organ failure incidence and outcomes in a contemporary, homogeneous trauma cohort.

Purpose of the Study:

  • To determine the current incidence and mortality of organ failure in critically ill trauma patients.
  • To identify risk factors associated with the occurrence of organ failure in this population.

Main Methods:

  • Prospective study of 869 trauma patients admitted to an urban Level I trauma center ICU.
  • Organ failure assessed using Knaus, Fry, and newer definitions including organ dysfunction and severity-of-illness scores (e.g., APACHE II/III, ISS, ARDS scores).

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  • Risk factors analyzed included injury mechanism, lactate levels, ISS, APACHE scores, ARDS scores, MODS, and blood product transfusion.

    • Main Results:

    • Single organ failure (SOF) occurred in 18.7% of patients, primarily respiratory failure; multiple organ failure (MOF) in 5.1%.
    • Mortality increased with the number of failed organ systems: 4.3% (1), 32% (2), 67% (3), and 90% (4+).
    • APACHE III, lactate at 24 hours, and total blood products transfused in 24 hours were associated with organ failure occurrence.

    Conclusions:

    • The incidence of organ failure in homogeneous trauma patients is lower than in older, heterogeneous studies.
    • SOF mortality is low, often related to underlying injuries rather than the failure itself.
    • Mortality for 2-3 organ system failures is reduced compared to previous decades, but remains high for 4+ organ failures.