Multiple organ dysfunction syndrome (MODS) prediction score in multi-trauma patients. (2017)

• Record Type: Journal Article
• Authors: Rendy, Leo; Sapan, Heber B.; Kalesaran, Laurens T.B.
• Is Part Of: International journal of surgery open. Volume 8(2017)
• Page Start: 1
• Page End: 6
• Publication Date: 2017
• Subjects: Multi-organ dysfunction syndrome (MODS) -- Multi-trauma -- Emergency department -- MODS prediction score; MODS Multiple organ dysfunction syndrome -- MOF Multiple organ failure -- SIRS Systemic inflammation response syndrome -- ATLS Advanced trauma life support -- DSTC Definitive surgical treatment care -- ISS Injury severity score -- RTS revised trauma score -- SOFA Sequential organ failure assessment -- GCS Glasgow coma scale -- TOF Trauma organ failure; Surgery -- Periodicals; 617.005
• DOI: 10.1016/j.ijso.2017.05.003
• Languages: English
• ISSNs: 2405-8572

Abstract

Abstract: Background: Multiple organ dysfunction syndrome (MODS) in patients with major trauma remains a frequent and devastating complication in emergency departments and intensive care units. Easily and accurately identifying patients at risk for MODS post-injury, especially in multi-trauma cases, is important. The aim of this study was to develop an instrument to predict the development of MODS in adult multi-trauma patients using clinical and laboratory data available in the first 24 h after trauma. Methods: We prospectively enrolled adult multi-trauma patients with Injury Severity Score (ISS) ≥16, between 16 and 65 years old, admitted to four academic Level-I trauma centers for 1 year between September 2014 and 2015. Sequential organ failure assessment score was used to determine MODS during hospitalization. A risk score was created from the final regression model consisting of significant variables as MODS predictors. Result: During the period of the study, 98 multi-trauma patients were included. The mean age was 35.2 years, and most were male (85.71%). The mean ISS was 23.6, mostly (76.53%) caused by blunt injury mechanism. MODS occurred in 43 patients (43.87%). The prediction risk score consists of Revised Trauma Score (<7.25) and lactate level ≥2.75 mmol/L. This study also verified several independent risk factors for post-multi-trauma MODS such as ISS >25, presence of systemic inflammatory response syndrome, shock grade 2 or more, and white blood cells >12, 000. Conclusion: We derived a novel simple and applicable instrument to predict MODS in adults following multi-trauma. The use of this scoring system may allow early identification of trauma patients who are at risk for MODS and result in more aggressive targeted resuscitation and damage control surgery. Trial registration: ISCRTN ISRCTN16661943. 09/11/2016 retrospectively registered. Highlights: Multitrauma may promote physiological disarray and a hyper-inflammatory state leading to MODS and MOF. Validating risk factors for MODS development at earliest stage will be beneficial to reduce mortality and morbidity. The prediction score calculation consist of RTS and lactate plasma level after acute multitrauma may predict MODS. The use of this scoring system may allow early identification of trauma patients in the first 24 h after multitrauma.