TY - JOUR
T1 - Validation of the Denver Emergency Department Trauma Organ Failure Score to Predict Post-Injury Multiple Organ Failure Presented, in part, at the Research Forum of the American College of Emergency Physicians' Scientific Assembly, Seattle, WA, October 2013.
AU - Vogel, Jody A.
AU - Newgard, Craig D.
AU - Holmes, James F.
AU - Diercks, Deborah B.
AU - Arens, Ann M.
AU - Boatright, Dowin H.
AU - Bueso, Antonio
AU - Gaona, Samuel D.
AU - Gee, Kaitlin Z.
AU - Nelson, Anna
AU - Voros, Jeremy J.
AU - Moore, Ernest E.
AU - Colwell, Christopher B.
AU - Haukoos, Jason S.
N1 - Publisher Copyright:
© 2016 American College of Surgeons.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Background Early recognition of trauma patients at risk for multiple organ failure (MOF) is important to reduce the morbidity and mortality associated with MOF. The objective of the study was to externally validate the Denver Emergency Department (ED) Trauma Organ Failure (TOF) Score, a 6-item instrument that includes age, intubation, hematocrit, systolic blood pressure, blood urea nitrogen, and white blood cell count, which was designed to predict the development of MOF within 7 days of hospitalization. Study Design We performed a prospective multicenter study of adult trauma patients between November, 2011 and March, 2013. The primary outcome was development of MOF within 7 days of hospitalization, assessed using the Sequential Organ Failure Assessment Score. Hierarchical logistic regression analysis was performed to determine associations between the Denver ED TOF Score and MOF. Discrimination was assessed and quantified using a receiver operating characteristics (ROC) curve. The predictive accuracy of the Denver ED TOF score was compared with attending emergency physician estimation of the likelihood of MOF. Results We included 2,072 patients with a median age of 46 years (interquartile range [IQR] 30 to 61 years); 68% were male. The median Injury Severity Score was 9 (IQR 5 to 17), and 88% of patients had blunt mechanism injury. Among participants, 1,024 patients (49%) were admitted to the ICU, and 77 (4%) died. Multiple organ failure occurred in 120 (6%; 95% CI 5% to 7%) patients and of these, 37 (31%; 95% CI 23% to 40%) died. The area under the ROC curve for the Denver ED TOF Score prediction of MOF was 0.89 (95% CI 0.86 to 0.91) and for physician estimation of the likelihood of MOF was 0.78 (95% CI 0.73 to 0.83). Conclusions The Denver ED TOF Score predicts development of MOF within 7 days of hospitalization. Its predictive accuracy outperformed attending emergency physician estimation of the risk of MOF.
AB - Background Early recognition of trauma patients at risk for multiple organ failure (MOF) is important to reduce the morbidity and mortality associated with MOF. The objective of the study was to externally validate the Denver Emergency Department (ED) Trauma Organ Failure (TOF) Score, a 6-item instrument that includes age, intubation, hematocrit, systolic blood pressure, blood urea nitrogen, and white blood cell count, which was designed to predict the development of MOF within 7 days of hospitalization. Study Design We performed a prospective multicenter study of adult trauma patients between November, 2011 and March, 2013. The primary outcome was development of MOF within 7 days of hospitalization, assessed using the Sequential Organ Failure Assessment Score. Hierarchical logistic regression analysis was performed to determine associations between the Denver ED TOF Score and MOF. Discrimination was assessed and quantified using a receiver operating characteristics (ROC) curve. The predictive accuracy of the Denver ED TOF score was compared with attending emergency physician estimation of the likelihood of MOF. Results We included 2,072 patients with a median age of 46 years (interquartile range [IQR] 30 to 61 years); 68% were male. The median Injury Severity Score was 9 (IQR 5 to 17), and 88% of patients had blunt mechanism injury. Among participants, 1,024 patients (49%) were admitted to the ICU, and 77 (4%) died. Multiple organ failure occurred in 120 (6%; 95% CI 5% to 7%) patients and of these, 37 (31%; 95% CI 23% to 40%) died. The area under the ROC curve for the Denver ED TOF Score prediction of MOF was 0.89 (95% CI 0.86 to 0.91) and for physician estimation of the likelihood of MOF was 0.78 (95% CI 0.73 to 0.83). Conclusions The Denver ED TOF Score predicts development of MOF within 7 days of hospitalization. Its predictive accuracy outperformed attending emergency physician estimation of the risk of MOF.
KW - Abbreviations and Acronyms Denver ED TOF Score Denver Emergency Department Trauma Organ Failure Score
KW - DHMC Denver Health Medical Center
KW - IQR interquartile range
KW - LOS length of stay
KW - MOF multiple organ failure
KW - OHSU Oregon Health Science University
KW - ROC receiver operating characteristics
KW - SOFA Sequential Organ Failure Assessment
KW - UCDMC University of California Davis Medical Center
UR - http://www.scopus.com/inward/record.url?scp=84952636611&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84952636611&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2015.10.010
DO - 10.1016/j.jamcollsurg.2015.10.010
M3 - Article
C2 - 26597706
AN - SCOPUS:84952636611
SN - 1072-7515
VL - 222
SP - 73
EP - 82
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 1
ER -