David J. Ciesla, M.D., of the Denver Health Medical Center, and colleagues analysed data on severely injured patients admitted to the Rocky Mountain Regional Trauma Center over the course of a 12-year period to determine whether the incidence and severity of multiple organ failure had decreased over the course of the last decade and to determine whether risk factors for multiple organ failure had changed over the course of the study.
Multiple organ failure was based on evaluation of four organ systems, pulmonary, liver, kidney and cardiac. Single organ failure is defined by a dysfunction grade of one or greater on a scale of zero (best) to three (worse). Post-injury multiple organ failure is defined by a total score for the four organ systems of four or more within 48 hours after injury.
Of the 1,244 severely injured patients admitted over the 12-year period, 112 patients (eight percent) died. Of the 339 (25 percent) who developed multiple organ failure, 90 (27 percent) died. Over the course of the study there was a significant increase in the age of patients admitted and the severity of their injuries. At the same time, the number of blood transfusions and proportion of patients receiving more than six units of blood decreased significantly. Blood transfusion was recognised as a consistent early risk factor for multiple organ failure in 1997, prompting a more judicious use of blood transfusions.
After adjusting statistically for all risk factors, the authors were able to determine that there had been a significant decrease in the rate of multiple organ failure; multiple organ failure in 1992 was almost twice the rate observed in 2002.
Further, the association between severity of injury and multiple organ failure became less strong in the second half of the study period, suggesting that the effect of injury severity on the development of multiple organ failure decreased over time, the authors report.
MEDICA.de; Source: American Medical Association (AMA)