Risk scores for multiple organ failure in patients with multiple traumas treated in a hospital Emergency Department: a retrospective observational study

BACKGROUND. Multiple organ failure (MOF) is the main cause of late death in patients hospitalized with multiple traumas in intensive care units. To prevent MOF, it is crucial to identify at-risk patients.
OBJECTIVE. To ascertain which of 4 risk scores (the Denver PostInjury MOF score [Denver MOF], the Sepsis-related Organ Failure Assessment [SOFA] score, the Marshall Multiple Organ Dysfunction [MOD] score, and the Denver Emergency Department Trauma Organ Failure [Denver ED TOF] score) would best predict mortality in polytrauma patients in our hospital emergency department.
METHODS. We studied 181 polytrauma patients over the age of 15 years who were brought to the emergency department in 2012 through 2018. The outcome of interest was 100-day mortality in patients who survived 48 hours. After excluding patients who died within 48 hours we calculated the risk scores for in-hospital MOD or MOF.
RESULTS. In the 181-patient series, 71.8% were men. The mean age was 49.8 years, and the mean injury severity score was 25.9. The predicted incidences of MOF by the 4 scores were as follows: 39.2% by the SOFA, 53% by the Denver ED TOF, 29.3% by the Marshall MOD, and 5% by the Denver MOF. The SOFA score emerged as probably the best predictor of 100-day mortality, with an area under the receiver operating characteristic curve of 0.773. The Denver ED TOF score had the best sensitivity, while the Denver MOF score had the best specificity.
CONCLUSIONS. The SOFA score gave the best balance between sensitivity and specificity. The Denver ED TOF score could be used for early risk screening, given that it can be calculated in less than 48 hours. Notwithstanding the results of our study suggest that, MOF and MOD still require more standardized definitions given the high incidence of morbidity and mortality in polytrauma patients.