A nomogram to calculate the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM)

Williams, David J.; Walker, Jason

doi:10.1002/bjs.9363

Cited by 10 publications

(5 citation statements)

References 16 publications

(20 reference statements)

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“…Nomograms can solve complex mathematical problems [22], sometimes beautifully, and the computer tools available make it easy and pleasing to generate them. In the field of medicine, nomograms have been used to calculate physiological parameters [23], [24], [25], [26], [27], assess clinical risk [28], [29] and, more recently, for time-critical calculation of drug doses and fluid resuscitation regimes [30], [31], [32]. Figure 5 shows an original nomogram that can be used to work out the fluorouracil dose calculation in this article.…”

Section: E Dose Calculation Using a Nomogrammentioning

confidence: 99%

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Using Nomograms to Reduce Harm from Clinical Calculations

Thimbleby

Williams

2013

2013 IEEE International Conference on Healthcare Informatics

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Abstract-Handheld calculators and computer spreadsheets are ubiquitous and taken for granted. However in hospitals, errors in routine calculations frequently occur -for instance after making an unnoticed typing slip, such as omitting a decimal point in a drug dose calculation -and can result in patient harm. This paper is concerned with dependable calculation, and examines user tasks and technologies for safer calculations in the clinical environment. We demonstrate significant differences in complexity, speed and accuracy between alternative methods of performing calculations.The recent raised awareness of latent coding errors in applications designed to perfom medical dosage calculations has resulted in the introduction of national regulations that require all medical apps to meet similar standards of safety and reliability as other items of medical equipment. This paper provides evidence that general purpose calculators are also unnecessarily hazardous in the clinical environment, and should be subject to similar regulation. This paper contributes to the current debate about the use of computer systems to improve healthcare, and argues that "the latest IT" does not automatically confer benefit: its effectiveness should be empirically evaluated like any other medical intervention.The combination of simple reliable low technology graphical calculation aids and high technology computers with touch screen interfaces offers potential for improvement in patient safety; however further development and stringent evaluation are required before deployment in safety critical environments.

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Section: E Dose Calculation Using a Nomogrammentioning

confidence: 99%

“…Other studies using Bland-Altman analysis to compare the accuracy of nomograms and general purpose calculators in the calculation of drug doses and physiological variables show that the nomogram is significantly more accurate than a general purpose calculator [29], [30], [27]. Empirical experiments are Table I.…”

Section: Empirical Evaluation Of Nomogramsmentioning

confidence: 99%

Using Nomograms to Reduce Harm from Clinical Calculations

Thimbleby

Williams

2013

2013 IEEE International Conference on Healthcare Informatics

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“… 20 21 22 23 Among these scoring systems, POSSUM has been validated in various surgical fields, and a nomogram based on POSSUM has been recently developed. 24 25 26 27 However, these scoring systems are used to predict general morbidity or mortality, whereas our nomogram is solely focused on the risk of intraabdominal abscess after gastrectomy in patients with gastric cancer.…”

Section: Discussionmentioning

confidence: 99%

Nomogram Estimating the Probability of Intraabdominal Abscesses after Gastrectomy in Patients with Gastric Cancer

et al. 2015

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PurposeIntraabdominal abscess is one of the most common reasons for re-hospitalization after gastrectomy. This study aimed to develop a model for estimating the probability of intraabdominal abscesses that can be used during the postoperative period.Materials and MethodsWe retrospectively reviewed the clinicopathological data of 1,564 patients who underwent gastrectomy for gastric cancer between 2010 and 2012. Twenty-six related markers were analyzed, and multivariate logistic regression analysis was used to develop the probability estimation model for intraabdominal abscess. Internal validation using a bootstrap approach was employed to correct for bias, and the model was then validated using an independent dataset comprising of patients who underwent gastrectomy between January 2008 and March 2010. Discrimination and calibration abilities were checked in both datasets.ResultsThe incidence of intraabdominal abscess in the development set was 7.80% (122/1,564). The surgical approach, operating time, pathologic N classification, body temperature, white blood cell count, C-reactive protein level, glucose level, and change in the hemoglobin level were significant predictors of intraabdominal abscess in the multivariate analysis. The probability estimation model that was developed on the basis of these results showed good discrimination and calibration abilities (concordance index=0.828, Hosmer-Lemeshow chi-statistic P=0.274). Finally, we combined both datasets to produce a nomogram that estimates the probability of intraabdominal abscess.ConclusionsThis nomogram can be useful for identifying patients at a high risk of intraabdominal abscess. Patients at a high risk may benefit from further evaluation or treatment before discharge.

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“…Calculations using nomograms can be accurate to three significant figures, and before the advent of modern computers they were widely used in diverse fields such as engineering, chemistry and medicine [13]. Nomograms are particularly useful in healthcare settings, where access to IT is often limited [14].…”

Section: Methodsmentioning

confidence: 99%

An aid to drug dosing safety in obese children: development of a new nomogram and comparison with existing methods for estimation of ideal body weight and lean body mass

Callaghan

Walker

2014

Anaesthesia

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SummaryThe risk of accidental over-dosing of obese children poses challenges to anaesthetists during dose calculations for drugs with serious side-effects, such as analgesics. For many drugs, dosing scalars such as ideal body weight and lean body mass are recommended instead of total body weight during weight-based dose calculations. However, the complex current methods of obtaining these dosing scalars are impractical in the peri-operative setting. Arbitrary dose adjustments and guesswork are, unfortunately, tempting solutions for the time-pressured anaesthetist. The study's aim was to develop and validate an accurate, convenient alternative. A nomogram was created and its performance compared with the standard calculation method by volunteers using measurements from 108 obese children. The nomogram was as accurate (bias 0.12 kg vs À0.41 kg, respectively, p = 0.4), faster (mean (SD) time taken 2.8 (1.0) min (vs 3.3 (0.9) min respectively, p = 0.003) and less likely to result in mistakes (significant errors 3% vs 19%, respectively, p = 0.001). We present a system that simplifies estimation of ideal body weight and lean body mass in obese children, providing foundations for safer drug dose calculation.

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A nomogram to calculate the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM)

Abstract: The nomogram provides a rapid, accurate, low-cost means of performing, visualizing and cross-checking POSSUM calculations.

Cited by 10 publications

References 16 publications

Using Nomograms to Reduce Harm from Clinical Calculations

Using Nomograms to Reduce Harm from Clinical Calculations

Nomogram Estimating the Probability of Intraabdominal Abscesses after Gastrectomy in Patients with Gastric Cancer

An aid to drug dosing safety in obese children: development of a new nomogram and comparison with existing methods for estimation of ideal body weight and lean body mass

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