Validation of the Denver Emergency Department Trauma Organ Failure Score to Predict Post-Injury Multiple Organ Failure Presented, in part, at the Research Forum of the American College of Emergency Physicians' Scientific Assembly, Seattle, WA, October 2013.

Jody A. Vogel, Craig D. Newgard, James F. Holmes, Deborah B. Diercks, Ann M. Arens, Dowin H. Boatright, Antonio Bueso, Samuel D. Gaona, Kaitlin Z. Gee, Anna Nelson, Jeremy J. Voros, Ernest E. Moore, Christopher B. Colwell, Jason S. Haukoos

Research output: Contribution to journalArticle

5 Citations (Scopus)

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. Study Design 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.

Original languageEnglish (US)
Pages (from-to)73-82
Number of pages10
JournalJournal of the American College of Surgeons
Volume222
Issue number1
DOIs
StatePublished - Jan 1 2016

Fingerprint

Organ Dysfunction Scores
Multiple Organ Failure
Hospital Emergency Service
Wounds and Injuries
Research
Hospitalization
Physicians
ROC Curve
Emergencies
Blood Pressure
Nonpenetrating Wounds
Injury Severity Score
Blood Urea Nitrogen
Leukocyte Count
Hematocrit
Intubation
Multicenter Studies

Keywords

  • Abbreviations and Acronyms Denver ED TOF Score Denver Emergency Department Trauma Organ Failure Score
  • DHMC Denver Health Medical Center
  • IQR interquartile range
  • LOS length of stay
  • MOF multiple organ failure
  • OHSU Oregon Health Science University
  • ROC receiver operating characteristics
  • SOFA Sequential Organ Failure Assessment
  • UCDMC University of California Davis Medical Center

ASJC Scopus subject areas

  • Surgery

Cite this

Validation of the Denver Emergency Department Trauma Organ Failure Score to Predict Post-Injury Multiple Organ Failure Presented, in part, at the Research Forum of the American College of Emergency Physicians' Scientific Assembly, Seattle, WA, October 2013. / Vogel, Jody A.; Newgard, Craig D.; Holmes, James F.; Diercks, Deborah B.; Arens, Ann M.; Boatright, Dowin H.; Bueso, Antonio; Gaona, Samuel D.; Gee, Kaitlin Z.; Nelson, Anna; Voros, Jeremy J.; Moore, Ernest E.; Colwell, Christopher B.; Haukoos, Jason S.

In: Journal of the American College of Surgeons, Vol. 222, No. 1, 01.01.2016, p. 73-82.

Research output: Contribution to journalArticle

Vogel, Jody A. ; Newgard, Craig D. ; Holmes, James F. ; Diercks, Deborah B. ; Arens, Ann M. ; Boatright, Dowin H. ; Bueso, Antonio ; Gaona, Samuel D. ; Gee, Kaitlin Z. ; Nelson, Anna ; Voros, Jeremy J. ; Moore, Ernest E. ; Colwell, Christopher B. ; Haukoos, Jason S. / Validation of the Denver Emergency Department Trauma Organ Failure Score to Predict Post-Injury Multiple Organ Failure Presented, in part, at the Research Forum of the American College of Emergency Physicians' Scientific Assembly, Seattle, WA, October 2013. In: Journal of the American College of Surgeons. 2016 ; Vol. 222, No. 1. pp. 73-82.
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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. Study Design 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.",
keywords = "Abbreviations and Acronyms Denver ED TOF Score Denver Emergency Department Trauma Organ Failure Score, DHMC Denver Health Medical Center, IQR interquartile range, LOS length of stay, MOF multiple organ failure, OHSU Oregon Health Science University, ROC receiver operating characteristics, SOFA Sequential Organ Failure Assessment, UCDMC University of California Davis Medical Center",
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T1 - Validation of the Denver Emergency Department Trauma Organ Failure Score to Predict Post-Injury Multiple Organ Failure Presented, in part, at the Research Forum of the American College of Emergency Physicians' Scientific Assembly, Seattle, WA, October 2013.

AU - Vogel, Jody A.

AU - Newgard, Craig D.

AU - Holmes, James F.

AU - Diercks, Deborah B.

AU - Arens, Ann M.

AU - Boatright, Dowin H.

AU - Bueso, Antonio

AU - Gaona, Samuel D.

AU - Gee, Kaitlin Z.

AU - Nelson, Anna

AU - Voros, Jeremy J.

AU - Moore, Ernest E.

AU - Colwell, Christopher B.

AU - Haukoos, Jason S.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - 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. Study Design 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.

AB - 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. Study Design 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.

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KW - IQR interquartile range

KW - LOS length of stay

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KW - OHSU Oregon Health Science University

KW - ROC receiver operating characteristics

KW - SOFA Sequential Organ Failure Assessment

KW - UCDMC University of California Davis Medical Center

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