[Scoring multiple organ failure after severe trauma. Comparison of the Goris, Marshall and Moore scores]. / Scoring des Multiorganversagens nach schwerem Trauma. Vergleich des Goris-, Marshall- und Moore-Scores.

INTRODUCTION: MOF scores are used to predict, describe and define organ failure. The aim of this study was to compare MOF scoring systems regarding their precision. METHODS: Data on the ICU course of 301 severely injured patients (PTS > 20, age > 16 years) were documented daily for calculation of three MOF Scores (Goris, Moore, Marshall) for 14 days. Every day the patients were graded by clinical criteria into a group with and a group without MOF by an experienced intensive care physician. The cut-off point for MOF was determined by ROC analysis for each score; the sensitivity and specificity were calculated. RESULTS: The patients were 36.3 +/- 1.0 years old, the mean injury severity was 36.2 +/- 0.7 points according to the PTS. Forty-seven (15.6%) of all patients died 17.7 +/- 5.6 days after trauma. The MOF incidence was 26.1%, the MOF mortality 58.4%. The calculated cut-off point for MOF was more than 4 points for the Goris and Marshall scores and more than 3 points for the Moore score. The Moore score is, with sensitivity of 81% and specificity of 88%, superior to the other scores. The Moore score identified 93 patients (30.9%) for MOF; this corresponds with a right answer in 85%. The lower specificity of the Goris and Marshall scores was due to the judgement of liver (GOT) and cardiovascular (PAH) dysfunction respectively. CONCLUSION: For evaluation of MOF after severe trauma the Moore score is superior to other scoring systems (sensitivity 81%; specificity 87%). A score of more than 3 points is associated with MOF. The Moore score did not consider distinct parameters (S-GOT, PAH) which are included in the other systems and were of little importance in our calculations.

[Long-term outcome after multiple organ failure following severe trauma]. / Langzeitverlauf nach Multiorganversagen bei Polytrauma.

OBJECTIVE: The aim of this follow-up study was to find out if severely injured patients with multiple organ failure (MOF) show any organotopic sequelae in the late course. Additionally the occupational rehabilitation result as well as the reasons for a poor occupational result were investigated. METHODS: A total of 50 MOF patients with an injury severity of 45.3 +/- 2.1 PTS points were followed up 4.9 +/- 0.3 years after trauma. In order to show any organotopic sequelae, patients were examined and laboratory tests for the function of the lungs (function test, Horovitz-quotient), liver (bilirubin, GOT, bleeding time), and kidnies (creatinine, urea) were performed. The functional (locomotion and neurological system) and occupational rehabilitation results as well as the reasons for a poor occupational result were analysed. RESULTS: The clinical examination as well the functional and laboratory tests showed mainly normal results but in in 25% of the patients a significantly decreased range of motion of the elbow, hip, knee and ankle joint was found. The "return to work rate" was 64%. Reasons for a poor occupational result were the severity of head injury, a decreased range of motion of the hip joint and general physical fitness. CONCLUSIONS: Severely injured patients who survive MOF during their intensive care treatment, show no sequelae of organ failure. The occupational rehabilitation results were excellent with a "return to work rate" of 64% which was dependent on the severity of head injury, a decreased range of motion of the hip joint and general physical fitness.