Proposed definitions for diagnosis, severity scoring, stratification, and outcome for trials on intraabdominal infection

Abstract

Analysis of the experience with scientific studies on patients with secondary intraabdominal infection has revealed that problems of interpretation and comparability between studies exist as they relate to variable diagnostic criteria, unmeasured severity of disease, and unclear outcome measures. A consistent system of definitions has been developed to address these deficiencies. Intraabdominal infection is defined as clinical peritonitis requiring both operative and microbiological confirmation for proof of infection. The APACHE II system is proposed for grading the severity of the infection and for stratification of patient risk of mortality. Mortality and time until death, on one hand, and recovery and time until recovery, on the other, are proposed as the main outcome measures, both being independently and positively defined. It is anticipated that this system of minimum rules will produce studies that can be compared, hence, accelerating knowledge and understanding about intraabdominal infection and its best treatment.

A comparative study between Mannheim peritonitis index and APACHE II in predicting the outcome in patients of peritonitis due to hollow viscous perforation

“…13,14 In actual MPI score predicts higher mortality rate (26%) in both survivors as well as in non survivors as compared to APACHE II score (15% A prediction accuracy of 84-90% has been reported for APACHE in the previous studies. [15][16][17] Dino et al in their study had reported sensitivity, specificity, positive predictive value and negative predictive value of APACHE as 82.5%, 54.7%, 82.8%, 66% respectively. In present study APACHE II is more specific than MPI in prediction of mortality.…”

Assessing the severity of intraabdominal Infections; the value of APACHE II Scoring System

“…Interpretation and comparison of results were made difficult by variable diagnostic criteria, ungraded severity of disease and unclear outcome measures 1,[13][14][15] . Meakins and associates aptly summarized the situation by showing the gross disparity between published mortality rate of 3.5% for antibiotic trials and rates up to 60% for intraabdominal infection associated with organ failure 13 .…”

“…In 1987, the Surgical Infection Society [SIS] adopted APACHE II the standard for stratification of intraabdominal infection ahead of scores designed specifically for sepsis, because, at that time, it had been prospectively validated in large patient populations 1,2 . Modifications such as the mode of score implementation, standard definition criteria and outcome measures for intraabdominal infection were approved by SIS.…”

“…Intraabdominal infection may be defined as clinical peritonitis with operative and microbiological proof of infection 1,2 . It consists of a spectrum of pathologies namely, primary, secondary and tertiary peritonitis and, intraabdominal abscess.…”

“…It consists of a spectrum of pathologies namely, primary, secondary and tertiary peritonitis and, intraabdominal abscess. In spite of innovations in operative and antimicrobial therapy, and intensive care, mortalities of 5-40% are being reported [1][2][3][4][5][6][7][8][9] . In our environment., peritonitis is a common cause of nontraumatic death in emergency unit with the scourge of typhoid perforation, late presentations of appendicitis and strangulated bowel being the key reasons [10][11][12] .…”