The changing pattern and implications of multiple organ failure after blunt injury with hemorrhagic shock.
OBJECTIVE
To describe the incidence of postinjury multiple organ failure and its relationship to nosocomial infection and mortality in trauma centers using evidence-based standard operating procedures.


METHODS
Prospective cohort study wherein standard operating procedures were developed and implemented to optimize postinjury care.


METHODS
Seven U.S. level I trauma centers.


METHODS
Severely injured patients (older than age 16 yrs) with a blunt mechanism, systolic hypotension (<90 mm Hg), and/or base deficit (≥6 mEq/L), need for blood transfusion within the first 12 hrs, and an abbreviated injury score ≥2 excluding brain injury were eligible for inclusion.


RESULTS
One thousand two patients were enrolled and 916 met inclusion criteria. Daily markers of organ dysfunction were prospectively recorded for all patients while receiving intensive care. Overall, 29% of patients had multiple organ failure develop. Development of multiple organ failure was early (median time, 2 days), short-lived, and predicted an increased incidence of nosocomial infection, whereas persistence of multiple organ failure predicted mortality. However, surprisingly, nosocomial infection did not increase subsequent multiple organ failure and there was no evidence of a "second-hit"-induced late-onset multiple organ failure.


CONCLUSIONS
Multiple organ failure remains common after severe injury. Contrary to current paradigms, the onset is only early, and not bimodal, nor is it associated with a "second-hit"-induced late onset. Multiple organ failure is associated with subsequent nosocomial infection and increased mortality. Standard operating procedure-driven interventions may be associated with a decrease in late multiple organ failure and morbidity.
University of Texas Southwestern Medical Center and Parkland Health and Hospital System, Dallas, TX, USA.
Joseph P
JP
Minei
Joseph
J
Cuschieri
Jason
J
Sperry
Ernest E
EE
Moore
Michael A
MA
West
Brian G
BG
Harbrecht
Grant E
GE
O'Keefe
Mitchell J
MJ
Cohen
Lyle L
LL
Moldawer
Ronald G
RG
Tompkins
Ronald V
RV
Maier
D000328:Adult; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012771:Shock, Hemorrhagic / Q000150:complications / Q000209:etiology*; D014193:Trauma Centers / Q000592:standards / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000150:complications*