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Biomedical subjects

J F Kraus

Publications and source records attributed to J F Kraus.

At least 19 recordsLinked to original sources
PubMed2004

Disability and risk of school related injury.

OBJECTIVE: Approximately six million children with disabilities attend school in the United States. Cognitive and physical limitations may compromise their ability to handle environmental hazards and hence increase their risk for injury. The objective of this study was to describe the epidemiology of school related injury among children enrolled in 17 special education schools in one large, urban school district. DESIGN: Altogether 6769 schoolchildren with disabilities were followed up from 1994-98. Injury and population data were collected from pupil accident reports and existing school records. Associations were estimated through generalized estimating equations. RESULTS: A total of 697 injuries were reported for a rate of 4.7/100 students per year. Children with multiple disabilities had a 70% increased odds of injury compared with the developmentally disabled (odds ratio (OR) 1.7, 95% confidence interval (CI) 1.3 to 2.3). The physically disabled (OR 1.4, 95% CI 1.0 to 1.9) had a modest increased odds of injury. Cuts, bruises, and abrasions composed almost three fourths of all injuries; almost half of these injuries were to the face. Falls (34%) and insults by other students (31%) were the most common external causes. More than a fourth of injuries were sports related, and 21% occurred on the playground/athletic field. Injury patterns differed across disabilities. CONCLUSIONS: Although limited to one school district, the population studied is the largest cohort thus far of schoolchildren with disabilities. With this large study base, potentially high risk groups were identified and circumstances of injury described. This information is imperative for developing and improving school based injury prevention measures.

Accidental Falls↗
PubMed2003

Nighttime driving, passenger transport, and injury crash rates of young drivers.

OBJECTIVE: This study examines the association of nighttime driving and the carrying of passengers with the rate of motor vehicle crashes that resulted in severe or fatal injury to young drivers in California before the implementation of a graduated licensing system. METHOD: Passenger vehicle drivers aged 16 or 17 involved in injury crashes in California from 1 January 1993 to 30 June 1998 were identified through a police crash database. An induced exposure method was used to estimate driving exposure. Odds ratios for driver injury crashes were estimated with logistic regression. RESULTS: Driving at night, driving without adult supervision, driving with passengers, using alcohol, being 16, and being male were associated with high rates of driver injury crash. CONCLUSIONS: The injury crash rate for drivers aged 16 or 17 increases during nighttime hours and in the absence of adult supervision, with or without other passengers. Driving between 10 pm and midnight is particularly dangerous for young drivers. Nighttime driving restrictions that begin at 10 pm or earlier and restrictions on carrying passengers at any hour may increase the effectiveness of graduated licensing systems.

Accidents, Traffic↗
PubMed2002

Regional brain injury epidemiology as the basis for planning brain injury treatment. The Romagna (Italy) experience.

AIM: Neurosurgical services for traumatic brain injury (TBI) should be based upon the understanding of the epidemiology of TBI in the region as well as the clinical parameters. Our objective was to measure incidence and epidemiologic factors associated with TBI in the Romagna region of Northeastern Italy and correlate those parameters with neurosurgical imaging and related clinical features. METHODS: Guidelines for brain injury management in our region were derived following meetings of all physicians involved in the treatment of brain injury. An epidemiologic study was undertaken in 1998. The study population was all patients admitted for hospital care in the Region following a TBI with a discharge diagnosis of pertinent International Classification Disease, 9(th) revision, codes. Data on the extent, diagnoses, severity, external causes and hospital course were abstracted from the hospital record and computer entered for analyses. RESULTS: Using data for the population of Romagna of about 1000000 persons we identified, in the full year 1998, 2430 TBI patients or an incidence rate of 250 per 100000 resident population. There were, in addition, 460 nonresident patients who were admitted in the region. External causes of injury were generally similar to reports from other places in Western Europe, with the exception of a very low frequency of cases stemming from violence. Age specific incidence rates were highest among young children, persons aged 15-24, and those aged 65 and older. Computerized tomography scans were given to 1732 patients and intracranial traumatic lesions were identified in 497 (28.6%) patients or a rate of 38 /100000. We performed 128 craniotomies, an incidence rate of 11/100000. The case fatality rate (CFR) was 2.8% among admitted patients with the highest rate among those aged 75 or older. CONCLUSION: Incidence of TBI in Italy is similar to other published European series. The number of minor brain injuries admitted for hospital care remains high and can be significantly reduced with better use of CT scans in adults whenever possible. The workload for a neurosurgical unit servicing a population of 1 million is limited and does not justify the opening of new units for trauma care or the use of craniotomies outside the Neurosurgical Unit.

Adolescent↗
PubMed2001

Assessment of hospital and police ascertainment of automobile versus childhood pedestrian and bicyclist collisions.

Information about automobile versus pedestrian or bicyclist collisions differ according to the source of collision ascertainment. Hospital records and police reports focus on different characteristics of a collision, which reflects differences in case finding as well as information regarding risk factors. Pedestrians and bicyclists 0-14 years of age who were involved in a motor vehicle collision in the city of Long Beach, CA, between January 1, 1992 and June 30, 1995, were included in the study. Police reports and medical records were used to identify cases. Police reports were found for 1,015 cases, and medical records identified 474 cases; 379 cases were common to both sources. A capture-recapture model was used to evaluate the degree of overlap between the two sources and to derive "ascertainment corrected" injury rates. The injury rate from combined sources was 333.5/100,000 children per year, the pedestrian injury rate was 210.6/100,000 children per year and the bicyclist injury rate was 122.9/100,000 children per year. The "ascertainment corrected" injury rate overall was 381.3/100,000 children per year, 233.0/100,000 for pedestrians and 153.9/100,000 children per year for bicyclists. Eighty percent of hospital-reported cases were captured in the police database, whereas only 37% of police-reported cases were captured by the hospital database. We found that hospital sources identified younger children, fewer bicyclists, more Asian and Hispanic children, and fewer African-American children when compared to police sources. For more comprehensive surveillance resulting in more accurate incidence rates and more complete information, it is better to use multiple sources of data.

Accidents, Traffic↗
PubMed2001

Analysis of fatal pedestrian injuries in Mexico City, 1994-1997.

Currently, in Mexico City, 57% of deaths from traffic crashes are pedestrian injuries. The purpose of this study was to identify and analyse the magnitude, trends, risks, and geographic distribution of fatal pedestrian injuries during the period 1994-1997. A cross-sectional study design was used, based on the death certificates of persons who were in Mexico City during 1994-1997 and died due to pedestrian injuries. Mortality rates, trend analysis, standard mortality ratios (SMRs), and potential years of life lost index (PYLLI) were calculated by gender, age groups and region (these correspond to "delegations", which are political divisions of the city). Rates were derived according to place of occurrence and place of residence. A total of 3687 pedestrian fatalities were reported, and 71% of these were to Mexico City residents. The rate for males was 10.6/100000 with a slight decrease in rate from 1994 to 1997. For females, the rate was 4.0/100000, with an increase in rate during the same years. The present study allowed identification of the target population as well as regions with a high risk of fatal pedestrian injuries. From these data we have developed or recommended specific interventions for prevention and control of fatal pedestrian injuries in Mexico City.

Accidents, Traffic↗
PubMed2001

Local television news coverage of traumatic deaths and injuries.

OBJECTIVE: To assess how local television news programs' reporting of injuries and deaths from traumatic causes compares with coroners' records of deaths and the estimated incidence of injuries in the same geographic area during the same time. METHODS: Using epidemiologic methods, we identified the underlying cause of death or injury in each of 828 local television news stories broadcast in Los Angeles during late 1996 or early 1997 that concerned recent (<3 days) traumatic injuries or deaths in Los Angeles County. Odds ratios were computed using deaths by homicide or injuries sustained in assaults as the referent group. RESULTS: The number of persons depicted as dead amounted to 47.8% of the actual total number of traumatic deaths occurring in Los Angeles County during the study period. In contrast, the number depicted as injured represented only 3.4% of injuries due to traumatic causes. Both injuries and deaths due to fires, homicides, and legal interventions were proportionally well represented. However, injuries and deaths from accidental poisoning, falls, and suicide were significantly underrepresented. CONCLUSIONS: Some types of events receive disproportionately more news coverage than others. Local television news tends strongly to present only those events concerned with death or injury that are visually compelling. We discuss reasons for concern about the effect that this form of information bias has on public understanding of health issues and possible counteractions that physicians can take.

Cause of Death↗
PubMed2001

A geographic analysis of motor vehicle collisions with child pedestrians in Long Beach, California: comparing intersection and midblock incident locations.

OBJECTIVES: The purpose of this study was to use geographic information system (GIS) software to locate areas of high risk for child pedestrian-motor vehicle collisions in the city of Long Beach and to compare risk factors between midblock and intersection collisions. METHODS: Children 0-14 years of age involved in a motor vehicle versus pedestrian collision that occurred on public roadways in Long Beach, CA, between 1 January 1992 and 30 June 1995, were identified retrospectively from police reports. The GIS software program, ArcView, was used for spatial analysis and distance calculations. chi2 Tests were used to compare the distribution of the characteristics between intersection and midblock collisions. RESULTS: The average annual incident and fatality rate was 183.3/100,000 children/ year and 2.4/100,000 children/year, respectively. Children less than 5 years of age were significantly more likely to be hit at a midblock location while those aged 5-9 and 10-14 were more often hit at an intersection. Intersection collisions were more likely to occur on major arterials and local streets, and the driver to be the primary party at fault (p<0.001). While intersection incidents tended to occur further from the child's home (64.4%) the majority of midblock incidents (61.5%) occurred within 0.1 miles of the child's residence. For both midblock and intersection locations, pedestrian collisions tended to occur more frequently in those census tracts with a larger number of families per census tract-a measure of household crowding and density. CONCLUSIONS: Future studies taking into consideration traffic volume and vehicle speed would be useful to focus prevention efforts such as environmental modifications, improving police enforcement, and educational efforts targeted at parents of younger children. As GIS illustrative spatial relationships continue to improve, relationships between pedestrian collision sites and other city landmarks can advance the study of pedestrian incidents.

Accidents, Traffic↗
PubMed2000

The independent effect of gender on outcomes following traumatic brain injury: a preliminary investigation.

Although epidemiological studies of gender differences in outcome after brain injury are limited, studies in animals indicate higher fatality rates for females. Studies in which healthy human brain metabolism was investigated also suggest gender differences. In this paper the authors examine gender as an independent predictor of survival following brain injury. A prospective cohort of severely and moderately brain injured individuals was identified from two trauma centers over a period of 3.5 years. Patients enrolled in the cohort were followed for as long as 18 months postdischarge. The Glasgow Outcome Scale was used to measure long-term outcome. Overall, mortality was 1.28 times higher in females than males, with the greatest difference of 2.14 found in deaths postdischarge. Controlling for age, admission Glasgow Coma Score, penetrating as compared with blunt injury, and the presence of multiple trauma, females were 1.75 times more likely than males to die of their brain injury (95% confidence interval 1.09-2.82). Furthermore, females were 1.57 times more likely to experience poor outcomes (that is, severe disability or persistent vegetative state) than males. These findings suggest the need to examine similar effects in different cohorts and to identify the pathophysiological basis for the differences observed in this epidemiological study.

Adolescent↗
PubMed2000

GIS mapping of earthquake-related deaths and hospital admissions from the 1994 Northridge, California, Earthquake.

PURPOSE: Earthquakes pose a persistent but unpredictable health threat. Although knowledge of geologic earthquake hazards for buildings has increased, spatial relations between injuries and seismic activity have not been explained. METHODS: Fatal and hospital-admitted earthquake injuries due to the 1994 Northridge Earthquake were identified. Geographical Information Systems software was used to map all injury locations. Injuries were analyzed with regard to distance from the earthquake epicenter, the Modified Mercalli Intensity Index, peak ground acceleration, and proportion of damaged residential buildings. RESULTS: Injury severity was inversely related to distance from the epicenter and increased with increasing ground motion and building damage. However, injury incidence and severity were not completely predicted by seismic hazard and building damage, and injuries of all severities occurred in a large geographic area. Average distance to the epicenter was smallest for injuries related to falling building parts and largest for cutting/piercing injuries and falls. CONCLUSIONS: The injuries from the Northridge Earthquake extended beyond the areas of highest environmental activity. Factors such as age and activity during the earthquake may be equally important in predicting injury from earthquakes as seismic features.

California↗
PubMed2000

Injury hospitalizations before and after the 1994 Northridge, California earthquake.

This study compared hospital-admitted injuries during the 14 days after the Northridge, California, earthquake of January 17, 1994, with hospital-admitted injuries during the preceding 16 days at the same facilities. Seventy-eight hospitals providing emergency care in Los Angeles County were screened; 16 were identified as having admitted at least one person for an earthquake-related injury. Retrospective chart reviews of hospitalized injuries for all of January 1994 were conducted at those facilities. The Northridge earthquake resulted in 138 injuries severe enough to require hospitalization. On the day of the earthquake, such injuries were 74% more frequent than usual overall. Some hospitals experienced as many as five times the number of injury admissions seen in the days preceding the event. The increase in caseload was short-lived, however; injury admissions tended to return to normal levels within two days after the quake. Previous reported estimates of the overall number of severe injuries caused by the Northridge earthquake appear to be exaggerated.

California↗
PubMed2000

Cross-national comparison of injury mortality: Los Angeles County, California and Mexico City, Mexico.

BACKGROUND: Cross-national comparisons of injury mortality can suggest possible causal explanations for injuries across different countries and cultures. This study identifies differences in injury mortality between Los Angeles (LA) County, California and Mexico City DF, Mexico. METHODS: Using LA County and Mexico City death certificate data for 1994 and 1995, injury deaths were classified according to the International Classification of Diseases Ninth Revision-Clinical Modification external cause of injury codes. Crude, gender-, and age-adjusted annual fatality rates were calculated and comparisons were made between the two regions. RESULTS: Overall and age-adjusted injury death rates were higher for Mexico City than for LA County. Injury death rates were found to be higher for young adults in LA County and for elderly residents of Mexico City. Death rates for motor vehicle crashes, falls, and undetermined causes were higher in Mexico City, and relatively high rates of poisoning, homicide, and suicide were found for LA County. Motor vehicle crash and fall death rates in Mexico City increased beginning at about age 55, while homicide death rates were dramatically higher among young adults in LA County. The largest proportion of motor vehicle crash deaths was to motor vehicle occupants in LA County and to pedestrians in Mexico City. CONCLUSIONS: These findings illustrate the importance of primary injury prevention in countries having underdeveloped trauma care systems and should aid in setting priorities for future work. The high frequency of pedestrian fatalities in Mexico City may be related to migration of rural populations, differing vehicle characteristics and traffic patterns, and lack of safety knowledge. Mexico City's higher rate of fall-related deaths may be due to concurrent morbidity from chronic conditions, high-risk environments, and delay in seeking medical treatment.

Accidents, Traffic↗
PubMed2000

Impact of a helmet law on two wheel motor vehicle crash mortality in a southern European urban area.

BACKGROUND: In Spain, a federal road safety law went into effect in the fall of 1992 extending to urban areas the unrestricted use of safety helmets by all two wheel motor vehicle occupants. OBJECTIVES: To assess the effect of the law in reducing fatal motorcycle crash injuries; to estimate the number of lives saved; and to determine changes in the distribution of severity and anatomical location of injuries. METHODS: Pre-test/post-test design of all deaths of two wheel motor vehicle occupants from 1990-92 (pre-law period) and from 1993-95 (post-law period) detected by the Barcelona Forensic Institute and the city police department. Injuries were coded using the 1990 version of the abbreviated injury scale. Poisson regression methods were used to model trends in mortality ratios and to provide estimates of the number of lives saved. RESULTS: Between 1993 and 1995, 35 lives of two wheel motor vehicle occupants were spared, representing a decrease of 25% in the observed motorcycle crash mortality in the post-law period when compared with what would be expected if no such law had gone into effect. The proportion of deaths with severe head injuries was also reduced from 76% to 67% in the post-law period. CONCLUSIONS: This study offers the first evaluation of a helmet law using combined forensic and police data in a large south European urban area where there is widespread use of motorcycles. Our results confirm the effectiveness of the helmet law, as measured by the reduction in the number of deaths and mortality ratios after the law implementation. The findings reinforce the public health benefits of mandatory non-restricted motorcycle and moped helmet use, even in urban areas with lower traffic speeds.

Accidents, Traffic↗
PubMed1999

Risk factors for injury to women from domestic violence.

BACKGROUND: Domestic violence is the most common cause of nonfatal injury to women in the United States. To identify risk factors for such injuries, we examined the socioeconomic and behavioral characteristics of women who were victims of domestic violence and the men who injured them. METHODS: We conducted a case-control study at eight large, university-affiliated emergency departments. The 256 intentionally injured women had acute injuries resulting from a physical assault by a male partner. The 659 controls were women treated for other conditions in the emergency department. Information was collected with a standardized questionnaire; no information was obtained directly from the male partners. RESULTS: The 256 intentionally injured women had a total of 434 contusions and abrasions, 89 lacerations, and 41 fractures and dislocations. In a multivariate analysis, the characteristics of the partners that were most closely associated with an increased risk of inflicting injury as a result of domestic violence were alcohol abuse (adjusted relative risk, 3.6; 95 percent confidence interval, 2.2 to 5.9); drug use (adjusted relative risk, 3.5; 95 percent confidence interval, 2.0 to 6.4); intermittent employment (adjusted relative risk, 3.1; 95 percent confidence interval, 1.1 to 8.8); recent unemployment (adjusted relative risk, 2.7; 95 percent confidence interval, 1.2 to 6.5); having less than a high-school-graduate's education (adjusted relative risk, 2.5; 95 percent confidence interval, 1.4 to 4.4); and being a former husband, estranged husband, or former boyfriend (adjusted relative risk, 3.5; 95 percent confidence interval, 1.5 to 8.3). CONCLUSIONS: Women at greatest risk for injury from domestic violence include those with male partners who abuse alcohol or use drugs, are unemployed or intermittently employed, have less than a high-school-graduate's education, and are former husbands, estranged husbands, or former boyfriends of the women.

Acute Disease↗
PubMed1999

Traumatic occupational fatalities in the retail industry, United States 1992-1996.

BACKGROUND: Retail is a growing economic sector and employs an increasing number of the overall workforce, yet little is known about the incidence and characteristics of work-related deaths in the retail industry. METHODS: Workplace deaths were examined using the Census of Fatal Occupational Injuries from 1992 through 1996. Occupational fatality rates were calculated by age, gender, and type of establishment, and characteristics of occupational deaths in the retail industry were compared to other industries. RESULTS: Liquor stores had the highest work-related fatality rates in the retail industry. The two leading causes of death in the retail industry were violence (69.5%) and motor vehicle crashes (19.3%). Females, younger, minority, and foreign-born workers were more likely to be killed in retail than other industries. Deaths in the retail industry were more likely to be in small businesses, after normal business hours, and in urban settings. DISCUSSION: Workers in the retail industry were at lower risk of most types of workplace deaths but had a markedly increased risk of violent death than workers in other industries.

Accidents, Traffic↗
PubMed1999

The prevalence of non-standard helmet use and head injuries among motorcycle riders.

OBJECTIVES: This study examined the prevalence of non-standard helmet use among motorcycle riders following introduction of a mandatory helmet use law and the prevalence of head injuries among a sample of non-standard helmet users involved in motorcycle crashes. METHODS: Motorcycle rider observations were conducted at 29 statewide locations in the 2 years following the introduction of the mandatory helmet use law in January, 1992. Medical records of motorcyclists who were injured in 1992 for whom a crash report was available and for whom medical care was administered in one of 28 hospitals were reviewed. Chi-squares and analysis of variance were used to describe differences between groups. RESULTS: Prevalence of non-standard helmet use averaged 10.2%, with a range across observation sites from 0 to 48.0%. Non-standard helmet use varied by type of roadway, day of week, and time of day. Injuries to the head were more frequent and of greater severity among those wearing non-standard helmets than both those wearing no helmet and those wearing standard helmets. CONCLUSIONS: Non-standard helmets appear to offer little head protection during a crash. Future study is needed to understand the dynamics leading to head injury when different types of helmets are worn.

Accidents, Traffic↗
PubMed1999

The specific deterrence of administrative per se laws in reducing drunk driving recidivism.

OBJECTIVE: To determine if administrative per se laws are more effective than other forms of sanction against drunk drivers. SEARCH STRATEGIES: The overall goal of the search strategy was to identify all relevant research concerning the specific effects of administrative per se laws in reducing drunk driving recidivism, traffic crashes, and other alcohol-related driving offenses by those drivers with suspended licenses. Known review articles and MEDLINE reviews formed the reference bibliography; numerous databases were searched from 1966 to the present, using such terms as alcohol, driver's license, recidivism, deterrence, and legislation. SELECTION CRITERIA: To be selected the study had to be designed to test the presence of an administrative per se license revocation or restriction in a defined cohort, have a suitable comparison cohort whose sanctions for drunk driving were not administrative per se, and provide relevant data that lead to an objective assessment of recidivism. Types of studies included were randomized controlled trials, nonrandomized controlled trials, other specialized cohort studies, and case-control studies. Three studies were identified; all met inclusion criteria. DATA COLLECTION AND ANALYSIS: One of the studies provided Kaplan-Meier survival curves for failure times defined as days to new conviction following the initial arrest. Odds ratios and 99% confidence intervals were extracted from two of the studies and additional information was supplied by the author of one of the studies. MAIN RESULTS: One study found that one state in the United States experienced a reduction of about one third in repeat arrests for drunk driving over a 3-year period among those who were arrested under administrative per se, relative to recidivism seen in a comparison cohort of drivers prior to administrative per se. Two other states did not experience any change in recidivism. The second study found that drivers whose licenses were suspended under administrative per se were 39% less likely during the first year following suspension to be rearrested on the charge of driving while intoxicated compared with a comparison cohort. This differential persisted into the second year of follow-up, but disappeared by the third year. The third study found both first offenders and repeat offenders arrested under administrative per se were 34% less likely to be involved during the year following their arrest in a subsequent motor vehicle crash compared with those in the comparison cohort. Drivers with administrative per se suspensions were 21% less likely to be involved in additional drunk driving offenses, and 27% less likely to be involved in reckless driving offenses related to alcohol. CONCLUSIONS: Administrative per se laws governing license restriction for drivers have been shown to be effective in some states but not others in decreasing the rates at which these same drivers are subsequently involved in a motor vehicle crash or in another alcohol-related offense, compared with drivers who were sanctioned through other conventional judicial processes. Replications are needed in other states or large driver populations using improved methodology.

Alcohol Drinking↗
PubMed1999

The relationship between socioeconomic factors and gang violence in the City of Los Angeles.

OBJECTIVE: To investigate the relationship between community-level socioeconomic factors and the incidence of gang-related homicide in the city of Los Angeles. METHODS: An ecological group-level analysis was conducted to correlate the 5-year incidence rates (from 1988 through 1992) of gang-related homicide with community-level socioeconomic statistics for the 18 geographically distinct Los Angeles Police Department divisions. Eight socioeconomic factors were examined: (1) log mean per capita income, (2) proportion employed, (3) proportion high school graduates, (4) proportion single-parent families, (5) proportion male, (6) proportion younger than 20 years of age, (7) proportion African American, and (8) proportion Hispanic. Pearson correlation coefficients were calculated for the interrelationships among the study variables and gang-related homicide. Adjusted regression estimates were calculated from a multiple linear regression model. RESULTS: The overall 5-year gang-related homicide rate for the city was 48.8 per 100,000, with a range of 5.2 to 173.5 per 100,000 among the different Los Angeles Police Department divisions. Pearson correlation coefficients revealed that the strongest negative correlations with gang-related homicide were log mean per capita income and proportion employed, and the strongest positive correlations were proportion single-parent families and proportion younger than 20 years of age. With mutual adjustment of all variables, only log mean per capita income and proportion employed were significantly associated with gang-related homicide. CONCLUSION: At the community level, gang-related homicide in Los Angeles is most closely associated with lower income and unemployment. These relationships may provide important insights into the causes of gang formation and gang violence.

Adolescent↗
PubMed1999

Multiple organ failure: by the time you predict it, it's already there.

OBJECTIVE: Validate an at-risk population to study multiple organ failure and to determine the importance of organ dysfunction 24 hours after injury in determining the ultimate severity of multiple organ failure. METHODS: We evaluated 105 patients admitted to five academic trauma centers during a 1-year period who survived for more than 24 hours with Injury Severity Scores > or = 25 and who received 6 or more units of blood. Organ dysfunction was scored daily with a modified multiple organ failure scoring system made up of individual adult respiratory distress syndrome score, renal dysfunction, hepatic dysfunction, and cardiac dysfunction scores. Multiple organ failure (MOF) severity was quantitated using the maximum daily multiple organ failure score and the cumulative sum of daily multiple organ failure scores for the first 7 days (MOF 7) and 10 days (MOF 10). Independent variables included markers of tissue injury, shock, host factors, physiologic response, therapeutic factors, and organ dysfunction within the first 24 hours after admission. Data were subjected to a conditional stepwise multiple regression analysis, first excluding and then including 24-hour MOF as an independent variable. RESULTS: Of the 105 high-risk patients, 69 (66%) developed a maximum daily multiple organ failure score > or = 1; 50 (72%) did so on day 1 one and 60 (87%) did so by day 2. In multiple regression models, the multiple correlation coefficient increased from 0.537 to 0.720 when maximum MOF was the dependent variable, from 0.449 to 0.719 when maximum daily MOF was the dependent variable, from 0.519 to 0.812 when MOF 7 was the dependent variable, and from 0.514 to 0.759 when MOF 10 was the dependent variable. CONCLUSION: We have confirmed that the population of patients with Injury Severity Scores > or = 25 who received 6 or more units of blood represent a high-risk group for the development of multiple organ failure. Our data also indicate that multiple organ failure after trauma is established within 24 hours of injury in the majority of patients who develop it. It appears that multiple organ failure is already present at the time when most published models are trying to predict whether or not it will occur.

Adult↗