Application of SOFA score to trauma patients

Objective:To assess the ability of the SOFA score (Sequential Organ Failure Assessment) to describe the evolution of organ dysfunction/failure in trau ma patients over time in intensive care units (ICU). Design: Retrospective analysis of a prospectively collected database. Setting: 40 ICUs in 16 countries. Patients: All trauma patients admitted to the ICU in May 1995. Main outcome measures and results: Incidence of dysfunction/failure of diff erent organs during the first 10 days of stay and the relation between the dysfunction, outcome, and length of stay. Included in the SOFA study were 1 81 trauma patients (140 males and 41 females). The non-survivors were signi ficantly older than the survivors (51 years +/- 20 vs 38 +/- 16 years, p < 0.05) and had a higher global SOFA score on admission (8 +/- 4 vs 4 +/- 3, p < 0.05) and throughout the 10-day stay. On admission, the non survivors h ad higher scores for respiratory ( > 3 in 47 % of non-survivors vs 17 % of survivors), cardiovascular ( > 3 in 24 % of non-survivors vs 5.7 % of survi vors), and neurological systems (> 4 in 41 % of non-survivors vs 16 % of su rvivors); although the trend was maintained over the whole study period, th e differences were greater during the first 4-5 days. After the first 4 day s, only respiratory dysfunction was significantly related to outcome. A hig her SOFA score, admission to the ICU from the same hospital, and the presen ce of infection on admission were the three major variables associated with a longer length of stay in the ICU (additive regression coefficients: 0.85 days for each SOFA point, 4.4 for admission from the same hospital, 7.26 f or infection on admission). Conclusions: The SOFA score can reliably describe organ dysfunction/failure in trauma patients. Regular and repeated scoring may be helpful for identi fying categories of patients at major risk of prolonged ICU stay or death.