Reduction in Mortality Rates of Postinjury Multiple Organ Dysfunction Syndrome: A Shifting Paradigm? A Prospective Population-Based Cohort Study.

Abstract

The incidence of multiple organ dysfunction syndrome (MODS) has decreased in the last decade by improvement in trauma care. However, it still remains a major cause of morbidity and mortality. This study investigated the current incidence and mortality of MODS in polytrauma patients. A 3-year prospective study included consecutive trauma patients admitted to a Level-1 Trauma Center Intensive Care Unit (ICU). Isolated head injuries, drowning, asphyxiation, and burns were excluded. Demographics, Injury Severity Score (ISS), physiologic parameters, resuscitation parameters, and Denver multiple organ failure (MOF) scores were prospectively collected. Data are presented as median (interquartile range [IQR]), P < 0.05 was considered significant. One hundred fifty-seven patients were included. Median age was 45 (26-61) years, 118 males (75%), ISS was 29 (22-37), 151 (96%) patients had blunt injuries. Thirty-one patients developed MODS (20%). Twenty-seven patients (17%) died, 24 due to brain and/or spinal cord injuries (89%). Only one patient (3%) died of MODS. Median highest Denver MOF score was 4 (4-5). Median time to MODS onset was 3 (3-4) days after injury with a length of 2 (1-3) days. Only seven patients (23%) had MODS for more than 3 consecutive days. Patients who developed MODS were older, needed more blood products in the emergency department, more platelets < 8 h and <24 h, stayed longer on the ventilator, longer in ICU and developed more often adult respiratory distress syndrome. There was however no difference in mortality between both groups. In this polytrauma population mortality was predominantly caused by brain injury. Even though MODS was still present in severely injured polytrauma patients, its presentation was only early onset, less severe during a shorter time period, and accompanied by lower mortality.