Background: The study attempts to define prognosis in acute abdomen cases using elderly modification (E-POSSUM) and compares its performance with physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth modification- (P-POSSUM).Methods: A non-randomized, prospective study was conducted between January 2016-November 2018 in 260 patients, aged ≥60 years old, undergoing elective and emergency general surgeries. Baseline characteristics, PS at the time of admission, surgery and OS at the moment of the patient’s discharge was obtained after formal ethical consent. The follow up period was 30 days post-surgery, and complications if any, were noted.Results: When exponential analysis was applied, POSSUM over predicted morbidity in low risk group (<30%), and though, it accurately predicted morbidity in higher risk strata, it was not statistically significant. Similarly, E-POSSUM accurately predicted morbidity for risk strata 60 -100 however, it was not significant when chi-square test was applied. However, when compared to POSSUM morbidity equation, E-POSSUM showed significant difference for risk strata 40-100 and 50-100. When exponential analysis was applied, E-POSSUM accurately predicted post-operative mortality similar to P-POSSUM. However, based on observed and expected ratio, E-POSSUM outperforms P-POSSUM in prediction of mortality.Conclusions: Exponential analysis of E-POSSUM better predicts morbidity and post-operative mortality risk in various acute abdomen cases when compared to POSSUM morbidity and P-POSSUM mortality equation. Hence, E-POSSUM is a valid scoring system for predicting morbidity and mortality risk in elderly patients undergoing elective and emergency surgery for acute abdomen.
Background: To compare the performance of Ranson’s Score (RS) and Glasgow Score (GS) with Revised Atlanta Classification (RAC) in prediction of mortality, and to check their suitability to replace RAC for surgical intervention of gallstone induced acute pancreatitis (GAP).Methods: A hospital based prospective study was conducted between April 2014 and May 2017 with patients presenting with GAP. RS and GS was evaluated using data in first 24 hours and at 48 hours post admission. Patients were classified into mild, moderate and severe based on RAC at the time of hospital stay. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each scoring system. Receiver Operating Characteristics (ROC) curves for mortality, ICU admission, Organ Failure (OF) and Gallstone Recurrence (GR) were plotted and predictive accuracy of each scoring system was measured by the Area under Curve (AUC). AUC values were compared for statistical significance using De Long test. A p-value of <0.05 was considered statistically significant.Results: Of 81 patients, 15 patients had OF and local complication classified as SAP, with persistent OF (16.0%). The AUC for RS was consistently the highest for predicting mortality (0.943), recurrence of gallstone (0.766), ICU-admission (0.801) and OF (0.852). RS had high specificity (61.9%), PPV (88.2%), Accuracy (90.1%) for predicting mortality, recurrence of gallstone and OF. Glasgow criteria had high sensitivity (85.1%), NPV (79.4) in predicting ICU-admission.Conclusions: RS in comparable with RAC in predicting mortality, GR in patients with GAP and early referral for surgical intervention.
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