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Reduction in Mortality Rates of Postinjury Multiple Organ Dysfunction Syndrome: A Shifting Paradigm? A Prospective
Karlijn J P van Wessem1, Luke P H Leenen
1Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Introduction:
The incidence of multiple organ dysfunction syndrome (MODS) has decreased in the last decade by improvement in trauma care. However, it still remains a major cause of morbidity and mortality. This study investigated the current incidence and mortality of MODS in polytrauma patients.
Patients And Methods:
A 3-year prospective study included consecutive trauma patients admitted to a Level-1 Trauma Center Intensive Care Unit (ICU). Isolated head injuries, drowning, asphyxiation, and burns were excluded. Demographics, Injury Severity Score (ISS), physiologic parameters, resuscitation parameters, and Denver multiple organ failure (MOF) scores were prospectively collected. Data are presented as median (interquartile range [IQR]), P < 0.05 was considered significant.
Results:
One hundred fifty-seven patients were included. Median age was 45 (26-61) years, 118 males (75%), ISS was 29 (22-37), 151 (96%) patients had blunt injuries. Thirty-one patients developed MODS (20%). Twenty-seven patients (17%) died, 24 due to brain and/or spinal cord injuries (89%). Only one patient (3%) died of MODS. Median highest Denver MOF score was 4 (4-5). Median time to MODS onset was 3 (3-4) days after injury with a length of 2 (1-3) days. Only seven patients (23%) had MODS for more than 3 consecutive days. Patients who developed MODS were older, needed more blood products in the emergency department, more platelets < 8 h and <24 h, stayed longer on the ventilator, longer in ICU and developed more often adult respiratory distress syndrome. There was however no difference in mortality between both groups.
Conclusions:
In this polytrauma population mortality was predominantly caused by brain injury. Even though MODS was still present in severely injured polytrauma patients, its presentation was only early onset, less severe during a shorter time period, and accompanied by lower mortality.
Insights
Multiple organ dysfunction syndrome (MODS) is less severe and has lower mortality in polytrauma patients, with brain injury being the primary cause of death. Improved trauma care has reduced MODS incidence and severity.
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Sepsis Research
Background:
- Multiple organ dysfunction syndrome (MODS) incidence has decreased due to improved trauma care but remains a significant cause of morbidity and mortality.
- This study aimed to investigate the current incidence and mortality of MODS in polytrauma patients.
Purpose of the Study:
- To determine the contemporary incidence and mortality rates of MODS in severely injured polytrauma patients.
- To analyze the characteristics and outcomes of MODS in this patient population.
Main Methods:
- A prospective 3-year study included 157 consecutive polytrauma patients admitted to a Level-1 Trauma Center ICU.
- Exclusions included isolated head injuries, drowning, asphyxiation, and burns. Data collected included demographics, Injury Severity Score (ISS), and Denver multiple organ failure (MOF) scores.
Main Results:
- MODS developed in 20% of patients; 17% died, primarily from brain/spinal cord injuries (89%).
- Only one death (3%) was attributed to MODS. MODS cases were early-onset (median 3 days), short-lived (median 2 days), and less severe.
- MODS patients were older, required more blood products, had longer ventilator and ICU stays, and higher rates of adult respiratory distress syndrome.
Conclusions:
- Brain injury is the predominant cause of mortality in this polytrauma cohort.
- While MODS still occurs, it presents with earlier onset, reduced severity, shorter duration, and lower mortality in current polytrauma care settings.
