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Temporal trends of postinjury multiple-organ failure: still resource intensive, morbid, and lethal
Angela Sauaia1, Ernest E Moore, Jeffrey L Johnson
1From the Schools of Public Health (A.S.), and Medicine (A.S., E.E.M., J.L.J., T.L.C., A.B., C.C.B.) University of Colorado Denver; and Denver Health Medical Center (E.E.M., J.L.J., C.C.B.), Denver, Colorado; University of Pittsburgh Medical Center (J.L.S.), Pittsburgh, Pennsylvania; and University of Washington Harborview Medical Center (R.V.M.), Seattle, Washington.
Background:
While the incidence of postinjury multiple-organ failure (MOF) has declined during the past decade, temporal trends of its morbidity, mortality, presentation patterns, and health care resources use have been inconsistent. The purpose of this study was to describe the evolving epidemiology of postinjury MOF from 2003 to 2010 in multiple trauma centers sharing standard treatment protocols.
Methods:
"Inflammation and Host Response to Injury Collaborative Program" institutions that enrolled more than 20 eligible patients per biennial during the 2003 to 2010 study period were included. The patients were aged 16 years to 90 years, sustained blunt torso trauma with hemorrhagic shock (systolic blood pressure < 90 mm Hg, base deficit ≥ 6 mEq/L, blood transfusion within the first 12 hours), but without severe head injury (motor Glasgow Coma Scale [GCS] score < 4). MOF temporal trends (Denver MOF score > 3) were adjusted for admission risk factors (age, sex, body max index, Injury Severity Score [ISS], systolic blood pressure, and base deficit) using survival analysis.
Results:
A total of 1,643 patients from four institutions were evaluated. MOF incidence decreased over time (from 17% in 2003-2004 to 9.8% in 2009-2010). MOF-related death rate (33% in 2003-2004 to 36% in 2009-2010), intensive care unit stay, and mechanical ventilation duration did not change over the study period. Adjustment for admission risk factors confirmed the crude trends. MOF patients required much longer ventilation and intensive care unit stay, compared with non-MOF patients. Most of the MOF-related deaths occurred within 2 days of the MOF diagnosis. Lung and cardiac dysfunctions became less frequent (57.6% to 50.8%, 20.9% to 12.5%, respectively), but kidney and liver failure rates did not change (10.1% to 12.5%, 15.2% to 14.1%).
Conclusion:
Postinjury MOF remains a resource-intensive, morbid, and lethal condition. Lung injury is an enduring challenge and should be a research priority. The lack of outcome improvements suggests that reversing MOF is difficult and prevention is still the best strategy.
Level Of Evidence:
Epidemiologic study, level III.
Insights
Postinjury multiple-organ failure (MOF) incidence decreased, but mortality and resource use remained unchanged. Lung injury is a persistent challenge, emphasizing prevention as the best strategy for this severe condition.
Area of Science:
- Trauma research
- Critical care medicine
- Epidemiology
Background:
- Postinjury multiple-organ failure (MOF) incidence has declined, yet trends in morbidity, mortality, and resource utilization remain inconsistent.
- Standardized treatment protocols were employed across multiple trauma centers.
Purpose of the Study:
- To describe the evolving epidemiology of postinjury MOF between 2003 and 2010.
- To analyze temporal trends in MOF presentation, morbidity, mortality, and healthcare resource use.
Main Methods:
- Analysis of data from the "Inflammation and Host Response to Injury Collaborative Program" (2003-2010).
- Inclusion of patients (16-90 years) with blunt torso trauma and hemorrhagic shock, excluding severe head injury.
- Statistical adjustment for admission risk factors using survival analysis to evaluate MOF trends (Denver MOF score > 3).
Main Results:
- MOF incidence decreased from 17% (2003-2004) to 9.8% (2009-2010).
- MOF-related death rates, ICU stay, and mechanical ventilation duration showed no significant change over the study period.
- Lung and cardiac dysfunction rates decreased, while kidney and liver failure rates remained stable.
Conclusions:
- Postinjury MOF continues to be a significant cause of morbidity and mortality, demanding substantial healthcare resources.
- Lung injury represents an ongoing challenge in MOF management, necessitating further research.
- The lack of improvement in outcomes highlights the difficulty in reversing MOF, reinforcing prevention as the primary strategy.
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