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Contemporary Patterns of Multiple Organ Dysfunction in Trauma.

Joanna M Shepherd1, Elaine Cole, Karim Brohi

  • 1Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK.

Shock (Augusta, Ga.)
|November 1, 2016
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Summary

Prolonged multiple organ dysfunction syndrome (PRMODS) is a distinct clinical entity in trauma patients, characterized by more severe organ dysfunction and higher mortality rates compared to early resolving MODS (ERMODS). This finding has implications for prognosis and treatment strategies.

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Area of Science:

  • Critical care medicine
  • Trauma surgery
  • Organ transplantation

Background:

  • Multiple organ dysfunction syndrome (MODS) significantly impacts trauma patient outcomes.
  • Distinct clinical presentations of MODS may influence prognosis and treatment.
  • Differentiating between early resolving MODS (ERMODS) and prolonged MODS (PRMODS) is crucial for critically injured patients.

Purpose of the Study:

  • To investigate if prolonged MODS (PRMODS) can be identified as a distinct clinical entity separate from early resolving MODS (ERMODS) in critically injured patients.
  • To analyze the clinical characteristics and outcomes associated with PRMODS.

Main Methods:

  • A prospective observational study included adult major trauma patients.
  • MODS was defined by a Sequential Organ Failure Assessment (SOFA) score >5.
  • PRMODS was defined as MODS lasting >7 days; time to recovery (TTR) was calculated based on SOFA scores.

Main Results:

  • Of 595 patients, 285 had ERMODS (48%) and 184 had PRMODS (31%).
  • PRMODS patients experienced more severe and protracted organ dysfunction (mean SOFA 11 vs. 6 on Day 2) and longer TTR (17 vs. 3 days).
  • PRMODS was linked to higher rates of hepatic/renal dysfunction, infection, and mortality (22% vs. 7%).

Conclusions:

  • Prolonged MODS (PRMODS) is a common and distinct clinical entity in trauma patients.
  • PRMODS is associated with significantly worse patient outcomes, including increased mortality.
  • PRMODS may serve as a critical endpoint in future trauma outcome studies.