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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
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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.

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).

Related Experiment Videos

  • 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.