Fröhlich Matthias, Wafaisade Arasch, Mansuri Anastasios, Koenen Paola, Probst Christian, Maegele Marc, Bouillon Bertil, Sakka Samir G
Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Ostmerheimerstr. 200, D-51109, Cologne, Germany.
Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimerstr. 200, D-51109, Cologne, Germany.
Scand J Trauma Resusc Emerg Med. 2016 Nov 3;24(1):130. doi: 10.1186/s13049-016-0321-5.
Multiple organ dysfunction and multiple organ failure (MOF) is still a major complication and challenge in the treatment of severely injured patients. The incidence varies decisively in current studies, which complicates the comparability regarding risk factors, treatment recommendations and patients' outcome. Therefore, we analysed how the currently used scoring systems, the MODS, Denver- and SOFA Score, influence the definition and compared the scores' predictive ability.
Out of datasets of severely injured patients (ISS ≥ 16, Age ≥ 16) staying more tha 48 h on the ICU, the scores were calculated, respectively. The scores' predictive ability on day three after trauma for resource requiring measurements and patient specific outcomes were compared using receiver-operating characteristics.
One hundred seventy-six patients with a mean ISS 28 ± 13 could be included. MODS and SOFA score defined the incidence of MOF consistently (46.5 % vs. 52.3 %), while the Denver score defined MOF in 22.2 %. The MODS outperformed Denver- and SOFA score in predicting mortality (area under the curve/AUC: 0.83 vs. 0.67 vs. 0.72), but was inferior predicting the length of stay (AUC 0.71 vs.0.80 vs.0.82) and a prolonged time on mechanical ventilation (AUC 0.75 vs. 0.81 vs. 0.84). MODS and SOFA score were comparably sensitive and the Denver score more specific in all analyses.
All three scores have a comparable ability to predict the outcome in trauma patients including patients with severe traumatic brain injury (TBI). Either score could be favored depending weather a higher sensitivity or specificity is targeted. The SOFA score showed the most balanced relation of sensitivity and specificity. The incidence of posttraumatic MOF relies decisively on the score applied. Therefore harmonizing the competing scores and definitions is desirable.
多器官功能障碍和多器官衰竭（MOF）仍是重症创伤患者治疗中的主要并发症和挑战。目前研究中其发病率差异很大，这使得在危险因素、治疗建议和患者预后方面的可比性变得复杂。因此，我们分析了当前使用的评分系统，即多器官功能障碍评分（MODS）、丹佛评分和序贯器官衰竭评估（SOFA）评分，如何影响定义，并比较了这些评分的预测能力。
从入住重症监护病房（ICU）超过48小时的重症创伤患者（损伤严重度评分[ISS]≥16，年龄≥16岁）的数据集中分别计算这些评分。使用受试者工作特征曲线比较创伤后第三天这些评分对资源需求测量和患者特定预后的预测能力。
纳入了176例平均ISS为28±13的患者。MODS和SOFA评分对MOF发病率的定义一致（46.5%对52.3%），而丹佛评分定义的MOF发病率为22.2%。在预测死亡率方面，MODS优于丹佛评分和SOFA评分（曲线下面积/AUC：0.83对0.67对0.72），但在预测住院时间（AUC 0.71对0.80对0.82）和机械通气时间延长方面较差（AUC 0.75对0.81对0.84）。在所有分析中，MODS和SOFA评分的敏感性相当，而丹佛评分更具特异性。
所有这三种评分在预测创伤患者（包括重度创伤性脑损伤[TBI]患者）的预后方面能力相当。根据目标是更高的敏感性还是特异性，可选择任一评分。SOFA评分显示出敏感性和特异性之间最平衡的关系。创伤后MOF的发病率在很大程度上取决于所应用的评分。因此，统一相互竞争的评分和定义是可取的。
