Predictive effect of the injury severity score on the development of multiple organ failure among young adults and elderly patients

Abstract

Study objectives: Multiple organ failure is a major cause of mortality in the injured patient, representing a significant financial burden to the health care system. Recent studies have demonstrated the importance of early prediction and early resuscitation for multiple organ failure to improve outcome. The objective of this study is to determine the correlation between Injury Severity Score (ISS) and multiple organ failure among severely injured young (aged 18 to 54 years) and elderly (aged 55 years) patients. Methods: This was a cross-sectional observational study from a hospital-based trauma registry. Data from 1997 were collected. All adult cases (>18 years) with acute trauma as defined by International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes and E-codes were included. Descriptive statistics were used to present group characteristics. For significance testing, χ 2 and Fisher's exact test were used for categorical variables. Severe injuries were defined by an ISS greater than 15. Presence of multiple organ failure was based on the definitions proposed by Knaus and Fry. Results: Six hundred forty-two adult trauma patients were included, with 469 classified as young and 173 as elderly. Among the 469 young adults, 193 had ISS greater than 15 (41.2%), and 35 of these developed multiple organ failure (35 of 193, or 18.1%). Among the 173 elderly patients, 88 had an ISS greater than 15 (50.9%), and 51 met the definition for multiple organ failure (51 of 173, or 29.5%). Severely injured (ISS >15) young and elderly groups were more likely to develop multiple organ failure compared with those with an ISS less than 15 ( P P P Conclusion: This study demonstrated a direct relationship between ISS greater than 15 and the development of multiple organ failure. We also observed a fivefold increase in the development of multiple organ failure among severely injured elderly patients. Future studies should focus on early resuscitative interventions based on prompt emergency department severity estimates calculated from anatomic and physiologic scoring systems. Limitations of this study are primarily related to the retrospective data collection process and the subsequent accuracy of the medical records.