title: Validation of the Denver Emergency Department Trauma Organ Failure Score to Predict Post-Injury Multiple Organ Failure.
abstract: BACKGROUND
  Early recognition of trauma patients at risk for multiple organ failure (MOF) is important to reduce the morbidity and mortality associated with MOF. The objective of the study was to externally validate the Denver Emergency Department (ED) Trauma Organ Failure (TOF) Score, a 6-item instrument that includes age, intubation, hematocrit, systolic blood pressure, blood urea nitrogen, and white blood cell count, which was designed to predict the development of MOF within 7 days of hospitalization.
  
  
  METHODS
  We performed a prospective multicenter study of adult trauma patients between November, 2011 and March, 2013. The primary outcome was development of MOF within 7 days of hospitalization, assessed using the Sequential Organ Failure Assessment Score. Hierarchical logistic regression analysis was performed to determine associations between the Denver ED TOF Score and MOF. Discrimination was assessed and quantified using a receiver operating characteristics (ROC) curve. The predictive accuracy of the Denver ED TOF score was compared with attending emergency physician estimation of the likelihood of MOF.
  
  
  RESULTS
  We included 2,072 patients with a median age of 46 years (interquartile range [IQR] 30 to 61 years); 68% were male. The median Injury Severity Score was 9 (IQR 5 to 17), and 88% of patients had blunt mechanism injury. Among participants, 1,024 patients (49%) were admitted to the ICU, and 77 (4%) died. Multiple organ failure occurred in 120 (6%; 95% CI 5% to 7%) patients and of these, 37 (31%; 95% CI 23% to 40%) died. The area under the ROC curve for the Denver ED TOF Score prediction of MOF was 0.89 (95% CI 0.86 to 0.91) and for physician estimation of the likelihood of MOF was 0.78 (95% CI 0.73 to 0.83).
  
  
  CONCLUSIONS
  The Denver ED TOF Score predicts development of MOF within 7 days of hospitalization. Its predictive accuracy outperformed attending emergency physician estimation of the risk of MOF.
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: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Newgard
authors.affiliation: Department of Emergency Medicine, University of California School of Medicine, Sacramento, CA.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
authors.affiliation: Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Diercks
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Arens
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO.
authors.forename: Dowin H
authors.initials: DH
authors.lastname: Boatright
authors.affiliation: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bueso
authors.affiliation: Department of Emergency Medicine, University of California School of Medicine, Sacramento, CA.
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Gaona
authors.affiliation: Department of Emergency Medicine, University of California School of Medicine, Sacramento, CA.
authors.forename: Kaitlin Z
authors.initials: KZ
authors.lastname: Gee
authors.affiliation: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR.
authors.forename: Anna
authors.initials: A
authors.lastname: Nelson
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Voros
authors.affiliation: Department of Surgery, Denver Health Medical Center, Denver, CO; Department of Surgery, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO; 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; 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: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis* / Q000209:etiology; D063305:Organ Dysfunction Scores; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult