Temporal patterns of organ dysfunction after severe trauma
| Autor: | Anders Oldner, Ola Friman, David W. Nelson, Elisabeth Hellgren, Jesper Eriksson, Anders Holst |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent Traumatic brain injury Organ Dysfunction Scores Multiple Organ Failure Critical Care and Intensive Care Medicine Time to death Trauma Clustering Sepsis Cohort Studies 03 medical and health sciences 0302 clinical medicine Intensive care Internal medicine medicine Humans 030212 general & internal medicine Organ system Retrospective Studies Sweden Sequential organ failure assessment business.industry RC86-88.9 Research Organ dysfunction 030208 emergency & critical care medicine Medical emergencies. Critical care. Intensive care. First aid medicine.disease Critical care Severe trauma Wounds and Injuries Female Data modelling medicine.symptom business Multiple organ dysfunction |
| Zdroj: | Critical Care, Vol 25, Iss 1, Pp 1-11 (2021) Critical Care |
| ISSN: | 1364-8535 |
| Popis: | Background Understanding temporal patterns of organ dysfunction (OD) may aid early recognition of complications after trauma and assist timing and modality of treatment strategies. Our aim was to analyse and characterise temporal patterns of OD in intensive care unit-admitted trauma patients. Methods We used group-based trajectory modelling to identify temporal trajectories of OD after trauma. Modelling was based on the joint development of all six subdomains comprising the sequential organ failure assessment score measured daily during the first two weeks post trauma. Further, the time for trajectories to stabilise and transition to final group assignments were evaluated. Results Six-hundred and sixty patients were included in the final model. Median age was 40 years, and median ISS was 26 (IQR 17–38). We identified five distinct trajectories of OD. Group 1, mild OD (n = 300), median ISS of 20 (IQR 14–27), had an early resolution of OD and a low mortality. Group 2, moderate OD (n = 135), and group 3, severe OD (n = 87), were fairly similar in admission characteristics and initial OD but differed in subsequent OD trajectories, the latter experiencing an extended course and higher mortality. In group 3, 56% of the patients developed sepsis as compared with 19% in group 2. Group 4, extreme OD (n = 40), received most blood transfusions, had the highest proportion of shock at admission and a median ISS of 41 (IQR 29–50). They experienced significant and sustained OD affecting all organ systems and a 28-day mortality of 30%. Group 5, traumatic brain injury with OD (n = 98), had the highest mortality of 35% and the shortest time to death for non-survivors, median 3.5 (IQR 2.4–4.8) days. Groups 1 and 5 reached their final group assignment early, > 80% of the patients within 48 h. In contrast, groups 2 and 3 had a prolonged time to final group assignment. Conclusions We identified five distinct trajectories of OD after severe trauma during the first two weeks post-trauma. Our findings underline the heterogeneous course after trauma and describe some potentially important clinical insights that are suggested by the groupings and temporal trajectories. |
| Databáze: | OpenAIRE |
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