title: Epidemiology and risk factors of multiple-organ failure after multiple trauma: an analysis of 31,154 patients from the TraumaRegister DGU.
abstract: BACKGROUND
  In the severely injured who survive the early posttraumatic phase, multiple-organ failure (MOF) is the main cause of morbidity and mortality. An enhanced prediction of MOF might influence individual monitoring and therapy of severely injured patients.
  
  
  METHODS
  We performed a retrospective analysis of a nationwide prospective database, the TraumaRegister DGU of the German Trauma Society. Patients with complete data sets (2002-2011) and a relevant trauma load (Injury Severity Score [ISS] ≥ 16), who were admitted to an intensive care unit, were included.
  
  
  RESULTS
  Of a total of 31,154 patients enclosed in this study, 10,201 (32.7%) developed an MOF according to the Sequential Organ Failure Assessment score. During the study period, mortality of all patients decreased from 18.1% in 2002 to 15.3% in 2011 (p < 0.001). Meanwhile, MOF occurred significantly more often (24.6% in 2002 vs. 31.5% in 2011, p < 0.001), but mortality of MOF patients decreased (42.6% vs. 33.3%, p < 0.001). MOF patients who died survived 2 days less (11 days in 2002 vs. 8.9 days in 2011, p < 0.001). Independent risk factors for the development of MOF following severe trauma were age, ISS, head Abbreviated Injury Scale (AIS) score of 3 or higher, thoracic AIS score of 3 or higher, male sex, Glasgow Coma Scale (GCS) score of 8 or less, mass transfusion, base excess of less than -3, systolic blood pressure less than 90 mm Hg at admission, and coagulopathy.
  
  
  CONCLUSIONS
  Over one decade, we observed an ongoing decrease of mortality after multiple trauma, accompanied by decreasing mortality in the subgroup with MOF. However, incidence of MOF in the severely injured increased significantly. Thus, MOF after multiple trauma remains a challenge in intensive care. The risk factors from multivariate analysis could be instrumental in anticipating the early development of MOF. Furthermore, a reliable prediction model might be supportive for patient enrolment in trauma studies, in which MOF marks the primary end point.
  
  
  METHODS
  Epidemiologic study, level III.
authors.affiliation: From the Department of Trauma and Orthopedic Surgery (M.F., C.P., T.P., M.M.S., M.M., B.B., A.W.), Institute for Research in Operative Medicine (IFOM) (R.L.), and Department of Anaesthesiology and Intensive Care Medicine (S.G.S.), Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Fröhlich
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.forename: Christian
authors.initials: C
authors.lastname: Probst
authors.forename: Thomas
authors.initials: T
authors.lastname: Paffrath
authors.forename: Marco M
authors.initials: MM
authors.lastname: Schneider
authors.forename: Marc
authors.initials: M
authors.lastname: Maegele
authors.forename: Samir G
authors.initials: SG
authors.lastname: Sakka
authors.forename: Bertil
authors.initials: B
authors.lastname: Bouillon
authors.forename: Arasch
authors.initials: A
authors.lastname: Wafaisade
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*