Introduction

The assessment of the patient with multiple organ failure requires the use of a system to score or stage the disease process. There is still no universally accepted method for judging the severity of organ dysfunction, and new systems are continually being developed and adapted for this purpose. Several elements must be considered in the development of a scoring system:

1. the ability to assess the function of individual organs as well as making a more global patient assessment;

2. the accessibility of the variables used in the score;

3. the concept that organ dysfunction is a continuum rather than a single event;

4. the time factor, since patients dying early may not have had time to develop multiple organ failure, and in those who do, the course over time is often variable, so that regular (daily) assessment is necessary.

The decision as to which organs should be included in any scale of organ dysfunction is largely dependent on the ability to measure organ function objectively. Organ failure can be assessed by the degree of abnormality of a single measure of function, a combination of variables defining a syndrome of abnormality, or the clinical intervention necessary to support the failing organ. The use of a single index offers simplicity but may lack specificity. A combination of variables increases specificity but may lose simplicity. Therapy-based variables are subject to different treatment protocols depending on the center.

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