Scoring des Multiorganversagens nach schwerem Trauma Vergleich des Goris-, Marshall- und Moore-Scores

摘要

Introduction: MOF scores are used to predict, describe and define organ failure. The aim of this study was to compare MOF scoring systems regarding their precision. Methods: Data on the ICU course of 301 severely injured patients (PTS > 20, age > 16 years) were documented daily for calculation of three MOF Scores (Goris, Moore, Marshall) for 14 days. Every day the patients were graded by clinical criteria into a group with and a group without MOF by an experienced intensive care physician. The cut-off point for MOF was determined by ROC analysis for each score; the sensitivity and specificity were calculated. Results: The patients were 36.3 ± 1.0 years old, the mean injury severity was 36.2 ± 0.7 points according to the PTS. Forty-seven (15.6 %) of all patients died 17.7 ± 5.6 days after trauma. The MOF incidence was 26.1 %, the MOF mortality 58.4 %. The calculated cut-off point for MOF was more than 4 points for the Goris and Marshall scores and more than 3 points for the Moore score. The Moore score is, with sensitivity of 81 % and specificity of 88 %, superior to the other scores. The Moore score identified 93 patients (30.9 %) for MOF; this corresponds with a right answer in 85 %. The lower specificity of the Goris and Marshall scores was due to the judgement of liver (GOT) and cardiovascular (PAH) dysfunction respectively. Conclusion: For evaluation of MOF after severe trauma the Moore score is superior to other scoring systems (sensitivity 81 %; specificity 87 %). A score of more than 3 points is associated with MOF. The Moore score did not consider distinct parameters (S-GOT, PAH) which are included in the other systems and were of little importance in our calculations.