Scott David Steenburg MD, Presenter: Nothing to Disclose

Travis Frantz, Abstract Co-Author: Nothing to Disclose

Todd McKinley MD, Abstract Co-Author: Nothing to Disclose

Greg Gaski MD, Abstract Co-Author: Nothing to Disclose

The Systemic Inflammatory Response Syndrome (SIRS) can lead to organ failure and death in multiply injured patients (MIPs). SIRS results primarily from an immune response to endogenous molecules thought to be liberated from damaged tissue. However, it is not known how the magnitude of tissue injury affects systemic inflammation and organ dysfunction. It is plausible that certain tissues are more prone to release of inflammatory mediators leading to SIRS, and that the magnitude of soft tissue injury may correspond with the degree of systemic inflammation and subsequent organ dysfunction. The purpose of this study was to determine how the total volume of soft tissue damage, as quantified on admission whole body CT scan, correlated with the magnitude of inflammation and organ dysfunction in MIPs.

Clinical data from 51 MIPs (ISS ≥ 18, age 18-65), admitted to the ICU for a minimum of 6 days, were used to calculate daily SIRS scores (0 to 4) and daily Sequential Organ Functional Assessment scores (SOFA; 0 - 24). The Soft Tissue Damage Volume Score (STDVS) was calculated by combining the volumetric measurements of all soft tissue injuries (extravascular blood products) in each patient as measured on admission whole body CT scans. Regression analyses evaluated correlations between STDVS and both SIRS and SOFA scores.

The results demonstrate two distinct patient populations; those at High Risk and those at Low Risk for subsequent inflammation and organ dysfunction. The average SIRS score vs STDVS slope was 10.5x higher in high risk patients (Fig 1, p<0.01) and average SOFA scores vs STDVS slope was 6.14X higher in high risk patients (, p<0.01). There is a linear relationship between the STDVS and the SIRS and SOFA scores for these two patient populations.

The magnitude of systemic inflammation and organ dysfunction is a function of STDVS. These results demonstrate a dichotomous response of how MIPs tolerate soft tissue damage, suggesting that some patients are at higher risk of systemic inflammation than others.

STDVS as calculated on admission CT may serve as a potential clinical tool for predicting systemic inflammation and organ dysfunction during the recovery process. Further investigations are required to elucidate the underlying pathophysiologic pathways for how soft tissue damage causes inflammation and organ dysfunction in MIPs.

Steenburg, S, Frantz, T, McKinley, T, Gaski, G, The Effect of Soft Tissue Damage Volume on Systemic Inflammation and Organ Failure in Multiple Injury Patients.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016262.html