Surgery pp 433-445 | Cite as

Risk Prediction, Disease Stratification, and Outcome Description in Critical Surgical Illness

  • John C. Marshall


The first half of the 20th century saw a number of important advances in the ability of the surgeon to care for the critically ill or multiply injured patient. An understanding of fluid resuscitation, the development of blood transfusion, 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 unprecedented series of clinical challenges—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 complex disorder has emerged as the leading unsolved problem in the management of the critically ill patient.


Intensive Care Unit Organ Dysfunction Sequential Organ Failure Assessment Sequential Organ Failure Assessment Score Simplified Acute Physiology Score 
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© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • John C. Marshall
    • 1
  1. 1.Department of Surgery, Critical Care MedicineUniversity of Toronto/St. Michael’s HospitalTorontoCanada

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