ORDIT: Organ Dysfunction in Trauma - A national point prevalence study

Background

Multiple organ dysfunction syndrome (MODS) is an exaggerated systemic inflammatory response following major tissue trauma. Recent reports suggest that the incidence of MODS has reduced, yet it remains a resource-intensive, morbid sequelae following serious injury. Despite advances in initial trauma management early fulminant MODS has the greatest association with mortality. Previous evidence suggests that the onset of MODS has a multimodal distribution with a peak incidence present within the first 24-72 hours following injury. However a phenotype of persistent inflammation-immunosuppression catabolism syndrome (PICS) has recently been described, characterised by a prolonged, late resolving MODS lasting more than seven days post injury. In the era of haemostatic resuscitation, damage control surgery and trauma networks the incidence, pattern and severity of MODS following major trauma in the UK have not been evaluated. The national trauma system is perfectly positioned to prospectively capture the current epidemiology and outcomes of MODS for injured patients admitted to UK Major Trauma Centres.

ORDIT Aims

Identify the prevalence of MODS in patients admitted to UK critical care units following major traumatic injury.
Investigate the severity and temporal variation of MODS in this cohort of patients.
Examine the incidence and mode of mortality associated with MODS following major traumatic injury.
Evaluate the relationship between MODS and other clinical outcomes.

Study Design

This was a one month (2016), prospective point prevalence cohort study of all trauma patients (≥16 years) admitted to UK Major Trauma Centre (MTC) adult critical care units.

The primary outcome was to describe the patterns of MODS following major trauma (identified using Sequential Organ Failure Assessment [SOFA] scoring).

Secondary outcomes included in-hospital mortality, organ support, duration of ventilation and length of stay.

Results

446 patients were enrolled, of which MODS developed in 251 (56%).

Cardiovascular and respiratory dysfunction were the greatest contributors to MODS in the majority of patients.

MODS carried a high mortality (24% vs. 1%, p<0.001) and 34% of deaths occurred early, within the first 48 hours after injury.

Three patterns of MODS were identified, all present on admission:

Cluster 1 MODS resolved early with a median time to recovery of four days and a mortality of 13%.

Cluster 2 had a delayed recovery (median 13 days) and mortality of 31%.

Cluster 3 had a prolonged recovery (median 25 days) and high associated mortality of 48%.

Multivariable analysis revealed distinct clinical associations for each form of MODS, with crystalloid administration strongly associated with Cluster 1 (p<0.001); brain injury with Cluster 2 (p<0.01); and admission shock severity with Cluster 3 (p<0.01).

Conclusions: Contemporary MODS is present within the first 24 hours from injury and has three distinct types based on patterns of recovery. Different clinical associations with MODS subtypes suggest opportunities for early stratification and targeted interventions.

SEE ORDIT STUDY PUBLICATION HERE

Chief investigator: Professor Karim Brohi, Queen Mary University of London

Principal investigator/Study coordinator: Dr Elaine Cole, Queen Mary University of London

For further details please email Elaine Cole