title: Temporal trends of postinjury multiple-organ failure: still resource intensive, morbid, and lethal.
abstract: BACKGROUND
  While the incidence of postinjury multiple-organ failure (MOF) has declined during the past decade, temporal trends of its morbidity, mortality, presentation patterns, and health care resources use have been inconsistent. The purpose of this study was to describe the evolving epidemiology of postinjury MOF from 2003 to 2010 in multiple trauma centers sharing standard treatment protocols.
  
  
  METHODS
  "Inflammation and Host Response to Injury Collaborative Program" institutions that enrolled more than 20 eligible patients per biennial during the 2003 to 2010 study period were included. The patients were aged 16 years to 90 years, sustained blunt torso trauma with hemorrhagic shock (systolic blood pressure < 90 mm Hg, base deficit ≥ 6 mEq/L, blood transfusion within the first 12 hours), but without severe head injury (motor Glasgow Coma Scale [GCS] score < 4). MOF temporal trends (Denver MOF score > 3) were adjusted for admission risk factors (age, sex, body max index, Injury Severity Score [ISS], systolic blood pressure, and base deficit) using survival analysis.
  
  
  RESULTS
  A total of 1,643 patients from four institutions were evaluated. MOF incidence decreased over time (from 17% in 2003-2004 to 9.8% in 2009-2010). MOF-related death rate (33% in 2003-2004 to 36% in 2009-2010), intensive care unit stay, and mechanical ventilation duration did not change over the study period. Adjustment for admission risk factors confirmed the crude trends. MOF patients required much longer ventilation and intensive care unit stay, compared with non-MOF patients. Most of the MOF-related deaths occurred within 2 days of the MOF diagnosis. Lung and cardiac dysfunctions became less frequent (57.6% to 50.8%, 20.9% to 12.5%, respectively), but kidney and liver failure rates did not change (10.1% to 12.5%, 15.2% to 14.1%).
  
  
  CONCLUSIONS
  Postinjury MOF remains a resource-intensive, morbid, and lethal condition. Lung injury is an enduring challenge and should be a research priority. The lack of outcome improvements suggests that reversing MOF is difficult and prevention is still the best strategy.
  
  
  METHODS
  Epidemiologic study, level III.
authors.affiliation: From the Schools of Public Health (A.S.), and Medicine (A.S., E.E.M., J.L.J., T.L.C., A.B., C.C.B.) University of Colorado Denver; and Denver Health Medical Center (E.E.M., J.L.J., C.C.B.), Denver, Colorado; University of Pittsburgh Medical Center (J.L.S.), Pittsburgh, Pennsylvania; and University of Washington Harborview Medical Center (R.V.M.), Seattle, Washington.
authors.forename: Angela
authors.initials: A
authors.lastname: Sauaia
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Johnson
authors.forename: Theresa L
authors.initials: TL
authors.lastname: Chin
authors.forename: Anirban
authors.initials: A
authors.lastname: Banerjee
authors.forename: Jason L
authors.initials: JL
authors.lastname: Sperry
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Maier
authors.forename: C Cothren
authors.initials: CC
authors.lastname: Burlew
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000191:economics / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D012771:Shock, Hemorrhagic / Q000209:etiology; D013898:Thoracic Injuries / Q000150:complications; D014193:Trauma Centers / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000150:complications* / Q000191:economics / Q000401:mortality; D014949:Wounds, Nonpenetrating / Q000150:complications; D055815:Young Adult