Contemporary patterns of multiple organ dysfunction in trauma.

Abstract

BACKGROUND: Multiple organ dysfunction syndrome (MODS) is associated with poor outcomes for trauma patients. Different forms of MODS may exist and have different consequences. The ability to distinguish them clinically may have implications for prognosis and treatment. We wished to study whether prolonged MODS (PRMODS) could be observed as a distinct clinical entity to early resolving MODS (ERMODS) in critically injured patients. METHODS: Adult major trauma patients recruited to a prospective observational study at a single major trauma centre were eligible for inclusion. MODS was defined as Sequential Organ Failure Assessment (SOFA) score >5; and PRMODS as lasting >7 days. Time to recovery (TTR) was calculated as the number of days before the SOFA fell below the MODS threshold (≤5). RESULTS: 595 patients were enrolled of which 285 developed ERMODS (48%) and 184 (31%) PRMODS. Organ dysfunction was more severe and protracted in PRMODS, especially in patients without brain injury (mean SOFA 11 vs. 6, Day 2, p < 0.001; TTR 17 vs. 3 days, p < 0.001). PRMODS exhibited higher rates of hepatic and renal dysfunction (84 vs. 56%; and 78 vs. 47%, p≤0.001). Patterns of recovery were distinct in hepatic, renal and neurological systems (TTR 15 vs. 4; 20 vs. 3; and 28 vs. 7 days, p < 0.01). PRMODS was associated with higher infection and mortality rates (91% vs. 40%; and 22% vs. 7%, p < 0.001). CONCLUSION: PRMODS appears common, a distinct clinical entity and associated with worse patient outcomes. PRMODS may represent an important endpoint for studies evaluating outcomes following trauma.