Validation of the Denver Trauma Organ Failure Score

描述（申请人提供）：创伤是美国发病率和死亡率的主要原因，也是大量医疗保健支出和生产力损失的来源。1 -4多器官功能衰竭（MOF）在最严重的受伤者中很常见，是受伤后即刻存活者发病率和死亡率的主要原因。5此外，创伤后发生多器官功能衰竭的患者需要长期的重症监护和专门的医疗资源。6 -8在创伤后早期快速准确地识别最有可能发生多器官功能衰竭的患者的能力将是非常有用的，并将允许更积极的、有针对性的治疗策略和集中的资源分配。不幸的是，以前没有标准来确定到达医院的那些患者最有可能发展为MOF。因此，我们最近推导并内部验证了一种多变量工具，丹佛创伤器官衰竭（TOF）评分，用于急诊科（艾德），以预测创伤患者随后发生的MOF。 第一个假设是，当应用于艾德中的大型异质性成人创伤人群时，丹佛TOF评分将准确预测住院7天内的MOF发展。第二个假设是，当应用于艾德的成人创伤患者时，丹佛TOF评分在预测住院7天内的MOF发展方面比急诊医生的临床判断更敏感和特异。第三个假设是，住院死亡率和重症监护资源利用率（由机械通气的需要和持续时间、侵入性操作、重症监护和住院时间的长度以及总费用定义）将分别在分为低风险（Denver TOF评分0-1）、中度（评分2-3）和高风险（评分e4）组的成人创伤患者中逐渐增加。 因此，具体目的包括：（1）使用来自西部急救服务转化研究网络（WESTRN）的三家机构进行多中心前瞻性队列研究，以外部验证丹佛TOF评分;（2）使用相同的三家机构进行多中心前瞻性队列研究，以比较丹佛TOF评分与急诊医生判断，以识别将发生MOF的患者;以及（3）进行单中心回顾性队列研究，以比较通过Denver TOF评分分为低、中、高风险组的患者的住院死亡率和重症监护资源利用。 公共卫生相关性：这项研究将产生一个有效的和可推广的损伤后多器官衰竭（MOF）预测工具，丹佛创伤器官衰竭（TOF）评分。丹佛TOF评分的使用可以允许：（1）选择需要更积极，更有针对性的复苏和监测的患者;（2）改善资源分配;（3）改善二级分类，以确定需要在指定的三级护理创伤中心护理的患者。最终，使用该工具可以降低器官衰竭的发生率，并降低与创伤相关的发病率、死亡率和经济负担。

DESCRIPTION (provided by applicant): Trauma is a leading cause of morbidity and mortality in the United States as well as a source of substantial health care expenditures and lost productivity.1-4 Multiple organ failure (MOF) is common among the most seriously-injured and is the leading cause of morbidity and mortality among those who survive the immediate post-injury period.5 In addition, patients who develop MOF following trauma require extended intensive care and specialized healthcare resources.6-8 The ability to rapidly and accurately identify patients most likely to develop MOF early in the post-injury period would be extremely useful and would allow for more aggressive, targeted therapeutic strategies and focused resource allocation. Unfortunately, no criteria previously existed to identify on arrival to the hospital those patients most at risk for the development of MOF. We therefore recently derived and internally validated a multivariable instrument, the Denver Trauma Organ Failure (TOF) Score, for use in the emergency department (ED) to predict subsequent development of MOF in trauma patients. The first hypothesis is that when applied to a large, heterogeneous adult trauma population in the ED, the Denver TOF Score will accurately predict the development of MOF within seven days of hospitalization. The second hypothesis is that when applied to adult trauma patients in the ED, the Denver TOF Score will be more sensitive and specific for predicting the development of MOF within seven days of hospitalization than clinical judgment of emergency physicians. The third hypotheses are that in-hospital mortality and intensive care resource utilization (defined by need for and duration of mechanical ventilation, invasive procedures, length of intensive care and hospital stay, and total costs) will increase incrementally among adult trauma patients categorized into low- (Denver TOF Score 0-1), moderate- (Score 2-3), and high-risk (Score e4) groups, respectively. The Specific Aims therefore include: (1) performing a multi-center prospective cohort study using three institutions from the Western Emergency Services Translational Research Network (WESTRN) to externally validate the Denver TOF Score; (2) performing a multi-center prospective cohort study using the same three institutions to compare the Denver TOF Score to emergency physician judgment for identifying those who will develop MOF; and (3) performing a single-center retrospective cohort study to compare in-hospital mortality and intensive care resource utilization among patients categorized into low-, moderate-, and high-risk groups by the Denver TOF Score. PUBLIC HEALTH RELEVANCE: The proposed research will result in a valid and generalizable post-injury multiple organ failure (MOF) prediction instrument, the Denver Trauma Organ Failure (TOF) Score. Use of the Denver TOF Score may allow for: (1) selection of patients who require more aggressive, targeted resuscitation and monitoring; (2) improved resource allocation; and (3) improved secondary triage to identify patients who require care at designated tertiary-care trauma centers. Ultimately, use of this instrument may decrease the incidence of organ failure and reduce the morbidity, mortality, and economic burden associated with trauma.