Incidence of multiple organ failure in adult polytrauma patients: A systematic review and meta-analysis

Ryan S Ting; Daniel P Lewis; Kevin X Yang; Tam Anh Nguyen; Pooria Sarrami; Lovana Daniel; Samuel Hourigan; Kate King; Christine Lassen; Mahsa Sarrami; William Ridley; Hatem Alkhouri; Michael Dinh; Zsolt J Balogh

doi:10.1097/TA.0000000000003923

Incidence of multiple organ failure in adult polytrauma patients: A systematic review and meta-analysis

J Trauma Acute Care Surg. 2023 May 1;94(5):725-734. doi: 10.1097/TA.0000000000003923. Epub 2023 Feb 21.

Authors

Ryan S Ting¹, Daniel P Lewis, Kevin X Yang, Tam Anh Nguyen, Pooria Sarrami, Lovana Daniel, Samuel Hourigan, Kate King, Christine Lassen, Mahsa Sarrami, William Ridley, Hatem Alkhouri, Michael Dinh, Zsolt J Balogh

Affiliation

¹ From the St George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales (R.S.T., K.X.Y., T.A.N.), Sydney; Department of Traumatology, Division of Surgery, John Hunter Hospital, Hunter Medical Research Institute (D.P.L., K.K., Z.J.B.), University of Newcastle, Newcastle; New South Wales Institute of Trauma and Injury Management Agency for Clinical Innovation; (P.S., M.D.) Department of Acute Care Surgery, Liverpool Hospital (L.D.); School of Medicine, The University of Notre Dame (S.H.); Faculty of Health, University of Technology Sydney (C.L.); Department of Traumatology, Royal North Shore Hospital (M.S.); Department of Traumatology, Concord Repatriation General Hospital (W.R.); and Emergency Care Institute, Agency for Clinical Innovation (H.A.), Sydney, New South Wales, Australia.

Abstract

Background: Postinjury multiple organ failure (MOF) is the leading cause of late death in trauma patients. Although MOF was first described 50 years ago, its definition, epidemiology, and change in incidence over time are poorly understood. We aimed to describe the incidence of MOF in the context of different MOF definitions, study inclusion criteria, and its change over time.

Methods: Cochrane Library, EMBASE, MEDLINE, PubMed, and Web of Science databases were searched for articles published between 1977 and 2022 in English and German. Random-effects meta-analysis was performed when applicable.

Results: The search returned 11,440 results, of which 842 full-text articles were screened. Multiple organ failure incidence was reported in 284 studies that used 11 unique inclusion criteria and 40 MOF definitions. One hundred six studies published from 1992 to 2022 were included. Weighted MOF incidence by publication year fluctuated from 11% to 56% without significant decrease over time. Multiple organ failure was defined using four scoring systems (Denver, Goris, Marshall, Sequential Organ Failure Assessment [SOFA]) and 10 different cutoff values. Overall, 351,942 trauma patients were included, of whom 82,971 (24%) developed MOF. The weighted incidences of MOF from meta-analysis of 30 eligible studies were as follows: 14.7% (95% confidence interval [CI], 12.1-17.2%) in Denver score >3, 12.7% (95% CI, 9.3-16.1%) in Denver score >3 with blunt injuries only, 28.6% (95% CI, 12-45.1%) in Denver score >8, 25.6% (95% CI, 10.4-40.7%) in Goris score >4, 29.9% (95% CI, 14.9-45%) in Marshall score >5, 20.3% (95% CI, 9.4-31.2%) in Marshall score >5 with blunt injuries only, 38.6% (95% CI, 33-44.3%) in SOFA score >3, 55.1% (95% CI, 49.7-60.5%) in SOFA score >3 with blunt injuries only, and 34.8% (95% CI, 28.7-40.8%) in SOFA score >5.

Conclusion: The incidence of postinjury MOF varies largely because of lack of a consensus definition and study population. Until an international consensus is reached, further research will be hindered.

Level of evidence: Systematic Review and Meta-analysis; Level III.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Humans
Incidence
Multiple Organ Failure / epidemiology
Multiple Organ Failure / etiology
Multiple Trauma* / complications
Multiple Trauma* / epidemiology
Organ Dysfunction Scores
Wounds, Nonpenetrating* / complications