Predicting the Destiny after Severe Traumatic Brain Injury; Multi Organ Dysfunction Syndrome (MODS) or Sequential Organ Failure Assessment (SOFA)?

Abstract

Purpose: To compare the outcome prediction ability of SOFA and MOD scoring systems, in the subset of ICU patients with severe traumatic brain injury. Materials and Methods: We performed a descriptive analytic study at Poursina hospital, a tertiary care trauma center. A number of 83 patients with severe traumatic brain injury who admitted to ICU between November 2012 and December 2013 were included. SOFA and MOD scores were calculated for each patient on a daily basis and areas under receiver operating characteristic curves were used to compare the discriminative ability of two scoring systems. Results: Out of 83 patients, 23 died (27.71%). AUROC curve for SOFA and MOD score were 0.514 and 0.510 respectively on admission, 0.587 and 0.512 on the second day of admission, 0.779 and 0.749 on the fourth day of admission and 0.978 and 0.824 after two weeks. Both systems were unreliable predictors of death for first 48 hours of admission. After 96 hours of admission, both systems represented an acceptable prediction ability, with no statistically significant difference between two tools (P value=0.850). In terms of outcome prediction, MOD scoring system performed good on fourteenth day with a significant difference when compared to excellent discriminant function of SOFA (P value=0.027). Conclusions: During the 48 hours of admission, none of scoring tools showed a reliable function of predicting the ICU mortality. They represented an acceptable discriminative ability after the fourth day of admission and better predictive ability after the fourteenth day of admission. After two weeks of admission, SOFA is superior to MODS in outcome prediction.