Validation of the use of POSSUM score in enteric perforation peritonitis - results of a prospective study

Abstract

IntroductionThe objective of the study was to present our last 5-years experience of peritonitis and validate POSSUM score in predicting mortality and morbidity in patients of enteric perforation (EP) peritonitis.MethodsData was collected prospectively for all peritonitis cases admitted in single surgical unit from January 2005 to December 2009. Parameters for calculating POSSUM were also retrieved; in these patients, O:E (Observed vs. Expected) ratio of mortality and morbidity were estimated after calculating predicted mortality and morbidity by exponential regression equations.Results887 patients with peritonitis were admitted and treated in this unit during the 5 years of study period. Duodenal (n=431; 48%) followed by ileal (n=380; 42.8%) perforations were the commonest. Mean age of the patients was 34 years and 86% were males. Mean delay in presentation was 78.5 hrs. Mean duration of hospital and ICU stay was 13 and 7.2 days. Postoperative complications were seen in 481 (54%) patients, and 90 (10%) patients died. POSSUM scores and predicted mortality/morbidity were calculated in 380 patients of ileal perforation peritonitis; O:E ratio of mortality and morbidity were 0.47 and 0.85 in these patients.ConclusionPOSSUM and P-POSSUM are accurate tools for predicting morbidity and mortality respectively in EP patients. Though they may sometime over or under predict morbidity as well as mortality.

Epidemiology and Management of Peritonitis at a Rural Hospital in Zambia

“…This fact demonstrates the importance of timely admission and high predictive value of the medical history length for mortality. Different scoring systems to assess severity and prognosis of peritonitis are found in literature (15,16). Developed in 1987, Mannheim peritonitis index (MPI) remains highly recommended (17).…”

“…Therefore, short history has clinical significance in reducing risk of death here. One should also recognize that with increasing duration of peritonitis, the risk of organ dysfunction increases, which was shown by one prospective study on enteric perforation peritonitis from India (2011) (15). The signs of impending or developed organ failure could be of especially high significance in low-resource rural environment in defining the level of care.…”

Predicting surgical outcomes of acute diffuse peritonitis: Updated risk models based on real‐world clinical data

“…Knowledge about risk factors for mortality of ADP has been accumulated as several scoring systems for evaluating the severity of ADP were reported, such as APACHE‐2, P‐POSSUM, or Mannheim peritonitis index 9–12 . Similarly, most scoring systems were developed from a dataset in an author's unit.…”

“…Knowledge about risk factors for mortality of ADP has been accumulated as several scoring systems for evaluating the severity of ADP were reported, such as APACHE‐2, P‐POSSUM, or Mannheim peritonitis index. 9 , 10 , 11 , 12 Similarly, most scoring systems were developed from a dataset in an author's unit. With the increasing usage of electric health records (EHR) in the medical and healthcare field, it has been recognized that using real‐world data from the EHR is significant in developing machine learning‐based predictive risk models.…”