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Validation of the Denver Trauma Organ Failure Score

丹佛创伤器官衰竭评分的验证

基本信息

批准号：
8514018
负责人：
Jody Ann Vogel
金额：
$ 6.72万
依托单位：
DENVER HEALTH AND HOSPITAL AUTHORITY
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-08-01 至 2014-07-31
项目状态：
已结题

项目摘要

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.

说明(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丧失的来源。1-4多器官衰竭(MOF)在最严重的伤者中很常见，在受伤后立即存活的人中是发病率和死亡率的主要原因。5此外，创伤后发展为MOF的患者需要延长的重症监护和专门的医疗资源。6-8能够快速准确地识别最有可能在受伤后早期发展为MOF的患者将非常有用，并将允许采取更积极、有针对性的治疗策略和有针对性的资源分配。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多器官功能衰竭。因此，我们最近推出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(ED)预测创伤患者随后发生的MOF。第一个假设是，当应用于急诊室中大量不同种类的成人创伤人群时，丹佛TOF评分将准确地预测住院7天内MOF的发展。第二个假设是，当应用于急诊室的成人创伤患者时，丹佛TOF评分对预测住院7天内MOF的发展将比急诊医生的临床判断更敏感和特异。第三个假设是，在分别分为低(Denver TOF评分0-1)、中等(评分2-3)和高危(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(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以及总成本定义)将逐渐增加。因此，具体目标包括：(1)利用西方急诊服务翻译研究网络(WESTRN)的三家机构进行一项多中心前瞻性队列研究，以从外部验证丹佛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，将丹佛TOF评分与急诊医生的判断进行比较，以确定哪些患者将发生MOF；以及(3)进行单中心前瞻性队列研究，以比较根据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的利用情况。