title: Denver ED Trauma Organ Failure Score outperforms traditional methods of risk stratification in trauma.
abstract: BACKGROUND
  Early identification of trauma patients at risk for inhospital mortality may facilitate goal-directed resuscitation and secondary triage to improve outcomes. The objective of this study was to compare prognostic accuracies of the Denver Emergency Department (ED) Trauma Organ Failure (TOF) Score, ED Sequential Organ Failure Assessment (SOFA) score, and ED base deficit and ED lactate for inhospital mortality in adult trauma patients.
  
  
  METHODS
  Consecutive adult trauma patients from 2005 to 2008 from the Denver Health Trauma Registry were included. Prognostic accuracies of the Denver ED TOF Score, ED SOFA score, ED base deficit, and ED lactate for inhospital mortality were evaluated with receiver operating characteristic curves.
  
  
  RESULTS
  Of the 4355 patients, the median age was 37 years (interquartile range [IQR], 26-51 years), median Injury Severity Score was 9 (IQR, 4-16), and 81% had blunt mechanisms. In addition, 38% (1670 patients) were admitted to the intensive care unit with a median intensive care unit length of stay of 2.5 days (IQR, 1-8 days), and 3% (138 patients) died. The areas under the receiver operating characteristic curves for the Denver ED TOF, ED lactate, ED base deficit, and ED SOFA were 0.94 (95% confidence interval [CI], 0.94-0.96), 0.88 (95% CI, 0.85-0.91), 0.82 (95% CI, 0.78-0.86), and 0.78 (95% CI, 0.73-0.82), respectively.
  
  
  CONCLUSIONS
  The Denver ED TOF Score more accurately predicts inhospital mortality in adult trauma patients compared to the ED SOFA score, ED base deficit, or ED lactate. The Denver ED TOF Score may help identify patients early who are at risk for mortality, allowing for targeted resuscitation and secondary triage to improve outcomes.
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO. Electronic address: jody.vogel@ucdenver.edu.
authors.forename: Jody A
authors.initials: JA
authors.lastname: Vogel
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO.
authors.forename: Nicole
authors.initials: N
authors.lastname: Seleno
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO.
authors.forename: Emily
authors.initials: E
authors.lastname: Hopkins
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Colwell
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO.
authors.forename: Craig
authors.initials: C
authors.lastname: Gravitz
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Department of Epidemiology, Colorado School of Public Health, Aurora, CO.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Haukoos
mesh_terms: D000328:Adult; D003120:Colorado; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D014218:Triage / Q000592:standards; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000401:mortality*