Validation of the Denver Trauma Organ Failure Score

描述（由申请人提供）：创伤是美国发病率和死亡率的主要原因，也是大量医疗支出和生产力损失的来源。1-4多器官衰竭（MOF）在最严重的损伤中很常见，是损伤后存活者发病和死亡的主要原因此外，创伤后发生MOF的患者需要长期的重症监护和专门的医疗资源。6-8在损伤后早期快速准确地识别最有可能发生MOF的患者的能力将非常有用，并将允许更积极、更有针对性的治疗策略和更集中的资源分配。不幸的是，以前没有标准可以在到达医院时确定哪些患者最有可能发展为MOF。因此，我们最近导出并内部验证了一个多变量工具，丹佛创伤器官衰竭（TOF）评分，用于急诊科（ED）预测创伤患者MOF的后续发展。第一个假设是，当将丹佛TOF评分应用于急诊科的大量异质成人创伤人群时，可以准确预测住院7天内MOF的发展。第二个假设是，当应用于急诊科的成人创伤患者时，丹佛TOF评分对于预测住院7天内MOF的发展比急诊医生的临床判断更敏感和特异性。第三个假设是，在低（丹佛TOF评分0-1）、中（评分2-3）和高风险（评分e4）组的成人创伤患者中，住院死亡率和重症监护资源利用率（由机械通气的需求和持续时间、有创手术、重症监护和住院时间以及总成本来定义）将分别逐渐增加。因此，具体目标包括：(1)使用西部急救服务转化研究网络（westn）的三家机构进行多中心前瞻性队列研究，从外部验证丹佛TOF评分；(2)采用相同的三家机构进行多中心前瞻性队列研究，比较丹佛TOF评分与急诊医生判断是否会发生MOF；(3)进行单中心回顾性队列研究，比较丹佛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情况。

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.