Multiple organ failure still a major cause of morbidity but not mortality in blunt multiple trauma

Background: Multiple organ failure (OF/MOF) was found to be the major compl ication after blunt multiple trauma during the last 25 years and was correl ated with a high mortality rate. Recently, several publications reported a decreased ARDS-related mortality, but there is little information about mor tality rates from posttraumatic MOF. The purpose of this study was to descr ibe the development of MOF-related death after blunt multiple trauma during the last 25 years. Method: Blunt multiple trauma patients with an Injury Severity Score (ISS) > 15 points were included in this evaluation. According to the year of trau ma, the population was divided into five groups: years 1975-1980 (n = 317), years 1981-1985 (n = 308), years 1986-1990 (n = 246), years 1991-1997 (n = 368), and years 1998-1999 (n = 122). Main outcome measurements were death, cause of death, and length of ICU stay. Patients dying within the first 24 hours after trauma were excluded. All data indicated in the Results sectio n are presented as mean SEM. Continuous variables were compared by ANOVA. O rdinal variables were analyzed by chi (2) contingency table analysis and, i f significant, subsequently by Fisher's exact test (two-tailed test, p < 0. 05). Results: Mean ISS remained unchanged between 1975-1980 (ISS 29 +/- 1) and 1 998-1999 (ISS 31 +/- 1) (p = 0.56). During the observation period, the mean age increased from 33 +/- 1 years (1975-1980) to 40 +/- 2 years (1998-1999 ) (p = 0.03). The overall incidence of OF/MOF slightly increased from 25.6% (1975-1980) to 33.6% (1998-1999) (p = 0.1). Length of ICU stay was not dif ferent between 1975-1980 (LOS: 14 +/- 1 d) and 1998-1999 (LOS: 19 +/- 2 d) (p = 1.0). The overall mortality decreased significantly, from 28.7% (1975- 1980) to 13.9% (1998-1999) (p < 0.001). While the mortality due to severe h ead injuries remained unchanged (1975-1980, 8.2%; 1998-1999, 9.0%) (p = 0.8 5), mortality due to OF/MOF decreased significantly (p < 0.001), from 18.0% (1975-1980) to 4.1% (1998-1999). The age of patients dying from OF/MOF inc reased significantly (p = 0.04) during the observation period, from 44 +/- 3 years (1975-1980) to 63 +/- 6 years (1998-1999). Conclusion: Although MOF incidence remains unchanged, there is a significan t fall in MOF-related mortality in patients with severe trauma, and death f rom single organ failure is virtually absent. Severe brain injury is now th e leading cause of death in patients with severe multiple injuries admitted to the ICU.