Lung Organ Failure Score (LOFS): probability of severe pulmonary organ failure after multiple injuries including chest trauma.
BACKGROUND
Pulmonary complications are common in multiple trauma patients with chest injury. Factors predisposing these critically ill patients to respiratory organ failure are not fully understood.


METHODS
Univariate and multivariate logistic regression analyses were used to assess the prognostic value of clinical and laboratory variables (2002-2008; n = 30,616) from the Trauma Registry of the German Trauma Society (DGU). Data from patients admitted to the ICU with lung contusion/lacerations, an Injury Severity Score ≥ 16 and age ≥ 18 were included in the study. Severe pulmonary organ failure was defined as PaO(2)/FiO(2)<200 for ≥ 3 days and based on the odds ratios (ORs) a simplified Lung Organ Failure Score (LOFS) was developed using integer values.


RESULTS
21.3% (1254) of the 5892 patients analysed developed severe pulmonary organ failure. We identified seven independent predictors with significant correlation: age, gender, head injury, fluid therapy, injury severity, degree of chest trauma and surgical interventions. The highest ORs were observed in cases of Abbreviated Injury Scale (AIS)(Thorax) = 5 (1.58), surgical intervention (1.71) and multiple surgeries (2.41). We found that patients with simplified score values ≥ 21 points were at a maximum risk (>30%) for developing severe pulmonary complications.


CONCLUSIONS
This scoring method could help trauma surgeons determine which multiple trauma patients are at risk for pulmonary complications after trauma. Efficacy analyses of prophylactic PEEP ventilation or rotational bed therapy in subgroups with comparable risks for respiratory complication could be based on the LOFS.
Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt, Germany. sebastian.wutzler@kgu.de
Sebastian
S
Wutzler
Arasch
A
Wafaisade
Marc
M
Maegele
Helmut
H
Laurer
Emanuel V
EV
Geiger
Felix
F
Walcher
John
J
Barker
Rolf
R
Lefering
Ingo
I
Marzi
D000328:Adult; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D016015:Logistic Models; D055370:Lung Injury / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D063305:Organ Dysfunction Scores; D011336:Probability; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000453:epidemiology; D013898:Thoracic Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D014057:Tomography, X-Ray Computed