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This study compared the updated SOFA-2 scoring system to the original SOFA-1 in 2,162 critically injured trauma patients across four major trauma centers. SOFA-2 classified fewer patients as having multiorgan dysfunction syndrome (MODS) than SOFA-1 (61.6% vs 68.5%), primarily due to lower respiratory and cardiovascular scores. However, 159 patients reclassified from MODS to no-MODS by SOFA-2 still showed significantly higher ICU mortality (7.5% vs 0.7%) and worse clinical outcomes than true no-MODS patients.
Why it matters
The findings reveal that while SOFA-2 may better identify severe organ dysfunction in trauma patients, it potentially misclassifies a small but clinically significant group with "occult MODS" who still face serious risks. This has important implications for trauma research design, patient care protocols, and how clinicians interpret organ dysfunction scores in severely injured patients.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Objective We aimed to evaluate the performance of the recently updated Sequential Organ Failure Assessment Score-2 (SOFA-2) on organ dysfunction classification and prognostication compared to SOFA-1 in critically injured trauma patients. Methods Adult trauma patients admitted to critical care at four urban Major Trauma Centres between 2011 and 2024 were included. Daily organ dysfunction scoring was performed using SOFA-1 and SOFA-2 until death or discharge. The primary outcome was MODS, defined as SOFA score [≥]6. Results In 2162 severely injured patients (median Injury Severity Score 25 [IQR, 17-34]), SOFA-2 reduced the proportion of patients classified as having MODS compared with SOFA-1 (61.6% vs 68.5%, p<0.001). SOFA-2 scores on the first day after admission were lower than SOFA-1 (median 6 [IQR, 3-8] vs 7 [IQR, 4-10], p<0.001), driven predominantly by lower respiratory and cardiovascular scoring. Critical care mortality in trauma patients was increased in respiratory, cardiovascular and renal components of SOFA-2 at the higher ends of the scores, consistent with the aims of the SOFA-2 reclassification. A group of 159 severely injured patients (7.3%) classified as MODS by SOFA-1 were reclassified to no-MODS by SOFA-2. Despite this reclassification, these patients had substantially higher ICU mortality (7.5% vs 0.7%, p<0.01), greater ventilator and vasopressor requirements, and longer hospital stays than patients classified as no-MODS by both systems. Conclusions SOFA-2 reduces MODS prevalence in severely injured patients and changes organ dysfunction classification, with lower rates of severe respiratory and cardiovascular dysfunction. This represents an important update in trauma MODS measurement and has implications for future trauma trial design. However SOFA-2 reclassification generates a small cohort a small but clinically significant group with occult MODS that warrants further evaluation in severely injured trauma patients.
Source: SOFA-2 reclassifies multiorgan dysfunction syndrome in major trauma patients