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Temporal patterns of organ dysfunction after severe trauma
Karolinska University Hospital, Sweden; Karolinska Institute, Sweden.
Karolinska University Hospital, Sweden; Karolinska Institute, Sweden.
RISE Research Institutes of Sweden, Digital Systems, Data Science. KTH Royal Institute of Technology, Sweden.ORCID iD: 0000-0001-8577-6745
Karolinska University Hospital, Sweden.
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2021 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 25, no 1, article id 165Article in journal (Refereed) Published
Abstract [en]

Background: Understanding temporal patterns of organ dysfunction (OD) may aid early recognition of complications after trauma and assist timing and modality of treatment strategies. Our aim was to analyse and characterise temporal patterns of OD in intensive care unit-admitted trauma patients. Methods: We used group-based trajectory modelling to identify temporal trajectories of OD after trauma. Modelling was based on the joint development of all six subdomains comprising the sequential organ failure assessment score measured daily during the first two weeks post trauma. Further, the time for trajectories to stabilise and transition to final group assignments were evaluated. Results: Six-hundred and sixty patients were included in the final model. Median age was 40 years, and median ISS was 26 (IQR 17–38). We identified five distinct trajectories of OD. Group 1, mild OD (n = 300), median ISS of 20 (IQR 14–27), had an early resolution of OD and a low mortality. Group 2, moderate OD (n = 135), and group 3, severe OD (n = 87), were fairly similar in admission characteristics and initial OD but differed in subsequent OD trajectories, the latter experiencing an extended course and higher mortality. In group 3, 56% of the patients developed sepsis as compared with 19% in group 2. Group 4, extreme OD (n = 40), received most blood transfusions, had the highest proportion of shock at admission and a median ISS of 41 (IQR 29–50). They experienced significant and sustained OD affecting all organ systems and a 28-day mortality of 30%. Group 5, traumatic brain injury with OD (n = 98), had the highest mortality of 35% and the shortest time to death for non-survivors, median 3.5 (IQR 2.4–4.8) days. Groups 1 and 5 reached their final group assignment early, > 80% of the patients within 48 h. In contrast, groups 2 and 3 had a prolonged time to final group assignment. Conclusions: We identified five distinct trajectories of OD after severe trauma during the first two weeks post-trauma. Our findings underline the heterogeneous course after trauma and describe some potentially important clinical insights that are suggested by the groupings and temporal trajectories. © 2021, The Author(s).

Place, publisher, year, edition, pages
BioMed Central Ltd , 2021. Vol. 25, no 1, article id 165
Keywords [en]
Clustering, Critical care, Data modelling, Multiple organ dysfunction, Trauma
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:ri:diva-53006DOI: 10.1186/s13054-021-03586-6Scopus ID: 2-s2.0-85105237671OAI: oai:DiVA.org:ri-53006DiVA, id: diva2:1557595
Note

Funding details: Karolinska Institutet, KI; Funding text 1: The Swedish Carnegie Hero Funds and funds from Karolinska Institute supported the study. Financial support was also provided through the regional agreement on medical and clinical research (ALF) between Stockholm County Council and Karolinska Institute. None of the funding agents were involved in the study design, data collection, data analysis, manuscript preparation, or publication decisions.

Available from: 2021-05-26 Created: 2021-05-26 Last updated: 2023-05-09Bibliographically approved

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