Epidemiology of postinjury multiple organ failure: a prospective multicenter observational study.

Epidemiology Multiple organ failure Polytrauma Trauma Trauma Center

Journal

European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350

Informations de publication

Date de publication:
12 Sep 2024
Historique:
received: 06 05 2024
accepted: 06 08 2024
medline: 12 9 2024
pubmed: 12 9 2024
entrez: 12 9 2024
Statut: aheadofprint

Résumé

Postinjury multiple organ failure (MOF) is the sequela to the disease of polytrauma. We aimed to describe the contemporary population-based epidemiology of MOF within a mature trauma system, to analyse the time taken for MOF to develop, and to evaluate the temporal patterns and contributions of the individual constituent organ failures. Prospective observational study conducted across five Level-1 trauma centers in New South Wales, Australia. Trauma patients at-risk of MOF (Denver > 3 from 48 h post-admission), aged > 16 years, ISS > 15, and who stayed in ICU for ≥ 48 h were eligible for inclusion. From May 2018-February 2021, 600 at-risk polytrauma patients were prospectively enrolled (mean(SD)age = 49(21)years, males = 453/600(76%),median(IQR)ISS = 26(20,34)). MOF incidence was 136/600(23%) among at-risk patients, 142/6248(2%) among major trauma patients (ISS > 12 per Australian definition), and 0.8/100,000 in the general population. The mortality rate was 55/600(11%) in the overall study population, and 34/136(25%) in MOF patients. 82/136(60%) of MOF patients developed MOF on day-3. No patients developed MOF after day-13. Among MOF patients, 60/136(44%) had cardiac failures (mortality = 37%), 39/136(29%) had respiratory failures (mortality = 23%), 24/136(18%) had renal failures (mortality = 63%), and 12/136(9%) had hepatic failures (mortality = 50%). Although a rare syndrome in the general population, MOF occurred in 23% of the most severely injured polytrauma patients. When compared to previous risk-matched cohorts, MOF become more common, but not more lethal, despite a decade older cohort. The heart has superseded the lungs as the most common organ to fail. Cardiac and respiratory failures occurred earlier and were associated with lower mortality than renal and hepatic failures.

Identifiants

DOI: 10.1007/s00068-024-02630-8 PMID: 39264428
pubmed: 39264428
doi: 10.1007/s00068-024-02630-8
pii: 10.1007/s00068-024-02630-8
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s).

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Auteurs

Ryan S Ting (RS)

St George & Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia.
ORCID: 0000-0003-0106-3129

Natasha A Weaver (NA)

University of Newcastle, Hunter Medical Research Institute, Newcastle, NSW, Australia.
ORCID: 0000-0002-9640-1647

Kate L King (KL)

John Hunter Hospital, University of Newcastle, Hunter Medical Research Institute, Newcastle, NSW, Australia.

Teagan L Way (TL)

John Hunter Hospital, University of Newcastle, Hunter Medical Research Institute, Newcastle, NSW, Australia.
ORCID: 0000-0002-4341-2879

Pooria Sarrami (P)

NSW Institute of Trauma and Injury Management, NSW Agency for Clinical Innovation and University of New South Wales, South West Sydney Clinical School, Sydney, NSW, Australia.
ORCID: 0000-0002-4034-1059

Lovana Daniel (L)

Westmead Hospital, University of New South Wales, South West Sydney Clinical School, Sydney, NSW, Australia.
ORCID: 0000-0003-1241-6567

Michael Dinh (M)

NSW Institute of Trauma and Injury Management, NSW Agency for Clinical Innovation and University of New South Wales, South West Sydney Clinical School, Sydney, NSW, Australia.

Priya Nair (P)

St Vincent's Hospital, Sydney, Australia.

Jeremy Hsu (J)

Westmead Hospital, Sydney, NSW, Australia.
ORCID: 0000-0002-7324-8088

Scott K D'Amours (SK)

Liverpool Hospital Trauma and Acute Care Surgery Unit, University of New South Wales, South West Sydney Clinical School, Sydney, NSW, Australia.
ORCID: 0009-0004-4975-7984

Zsolt J Balogh (ZJ)

John Hunter Hospital, University of Newcastle, Hunter Medical Research Institute, Newcastle, NSW, Australia. zsolt.balogh@health.nsw.gov.au.
Department of Traumatology, Division of Surgery, John Hunter Hospital, Hunter Region Mail Centre, University of Newcastle, Locked Bag 1, Newcastle, NSW, 2310, Australia. zsolt.balogh@health.nsw.gov.au.
ORCID: 0000-0002-0277-4822

Classifications MeSH