Surgery pp 305-320 | Cite as

Risk Prediction and Outcome Description in Critical Surgical Illness

  • John C. Marshall


The first half of the twentieth century brought a number of important advances in the ability of the surgeon to care for the critically ill or multiply injured patient. An understanding of the critical role of fluid resuscitation in the treatment of shock, the development of blood transfusion, the development of techniques to monitor and support the circulation, the introduction of parenteral nutritional support, and the development of positive pressure mechanical ventilation and hemodialysis all served to reduce the mortality for wartime trauma from close to 100% at the turn of the century to less than 5% by the time of the Vietnam War.1 Rapid death from acute physiological insufficiency gave way to uncomplicated recovery for some; for others, it opened the door to an entirely new series of problems—the sequelae of life-threatening physiological instability and of the deleterious consequences of the interventions employed to sustain life during a period of otherwise lethal organ system insufficiency. Known as the multiple organ dysfunction syndrome (MODS),2 this panoply of clinical problems has emerged as the leading unsolved problem in the management of the critically ill.


Sequential Organ Failure Assessment Sequential Organ Failure Assessment Score Multiple Organ Dysfunction Syndrome Simplified Acute Physiology Score Prognostic Score 
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© Springer Science+Business Media New York 2001

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  • John C. Marshall

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