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A simplified Sequential Organ Failure Assessment score is associated with 30-day trauma mortality: A novel tool for a
Christiaan A Rees1, Mengli Xiao, Jessica Wild
1From the Division of Pulmonary Sciences and Critical Care Medicine (C.A.R.), University of Colorado School of Medicine; Department of Biostatistics and Informatics (M.X., J.W.), Colorado School of Public Health, University of Colorado Anschutz Medical Campus; Department of Emergency Medicine (M.J., J.D., N.-K.M.-M.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora; Division of Surgery, Department of Surgical Sciences (H.L., G.O., E.S.), Stellenbosch University; Collaborative for Emergency Care in Africa (S.d.V.); Division of Forensic Medicine, Department of Pathology, Stellenbosch University (J.V.); Western Cape Government Health and Wellness (M.M., L.H., K.D., L.W., L.S., D.L.), Cape Town, South Africa; and Department of Anesthesiology (S.G.S.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora.
Background:
The Sequential Organ Failure Assessment (SOFA) scoring system has been validated across a range of critically-ill populations, including trauma patients, and is positively associated with risk of mortality. SOFA relies on measurement of creatinine, bilirubin, and platelets, which are laboratory values that may not be readily available in resource-limited practice settings. The present study describes a three-variable simplified Sequential Organ Failure Assessment (sSOFA) score that can be measured at bedside without the need for serum biomarkers.
Methods:
The present study is a secondary analysis of the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study, a prospective, multisite, observational cohort study enrolling patients presenting to health care facilities in the Western Cape of South Africa following major trauma. Individuals enrolled in EpiC who had one or more complete SOFA scores within the first 7 days of hospital admission were included. Simplified SOFA, which was calculated using only Glasgow Coma Scale, mean arterial pressure, and oxygen saturation, was compared with SOFA with respect to predicting mortality at 30 days.
Results:
The present study included 1,727 patients, of whom 339 (20%) experienced the endpoint of mortality within 30 days. For both SOFA and sSOFA, a higher maximum score within the first 7 days of hospitalization was associated with an increased risk of mortality, ranging from approximately 1% for a score of 0 or 1 to approximately 80% or above for a score of 12 or greater. The area under the receiver operating characteristic curves for SOFA and sSOFA were similar (0.869 vs. 0.861, p = 0.06).
Conclusion:
A three-variable SOFA-derived scoring system that can be easily measured at bedside performs comparably to the traditional six-variable SOFA score that relies on the availability of serum biomarkers. This scoring system has potential applications in resource-limited practice settings, where laboratory values may not be readily available.
Level Of Evidence:
Diagnostic Tests or Criteria; Level III.
