Non-neurological organ dysfunction in neurocritical care

Purpose: To determine the incidence of non-neurological organ dysfunction in patients with severe neurological injury. Materials and Methods: Modified daily SOFA (mSOFA) scores were retrospectively calculated for 55 consecutive patients with severe head injury or subarachnoid hemorrhage. mSOFA was defined as the sum of the 5 non-neurological component SOFA scores, maximum mSOFA as the sum of the most abnormal non-neurological SOFA component scores and delta mSOFA as the difference between maximum mSOFA and admission mSOFA. Organ failure was defined as a SOFA component score greater than or equal to3. Results: Median (IQR) admission, maximum and delta mSOFA scores were 4 (3-6),8 (6-9), and 2 (1-5), respectively. Respiratory and cardiac failure developed in 80% and 82% of patients, respectively. No patient developed renal or hepatic failure. Three patients developed hematological failure. There was no difference between survivors and nonsurvivors with respect to admission mSOFA (P = .45), maximum mSOFA (P = .54), or delta mSOFA (P = .19). There was no difference between those patients with favorable or unfavorable neurological outcome with respect to admission mSOFA (P = .24), maximum mSOFA (P = .84), or delta mSOFA (P = .20). Conclusions: Cardiopulmonary failure, as defined by SOFA, is common in intensive care unit patients with severe head injury and subarachnoid hemorrhage. In contrast to other intensive care unit patient populations, the mortality of patients with closed head injury or subarachnoid hemorrhage was not related to the severity of organ dysfunction on admission or its development during the intensive care unit stay. (C) 2003 Elsevier Inc. All rights reserved.