Key result
APACHE II and p-POSSUM scoring systems demonstrated higher sensitivity (89.2% and 85.2%) and specificity (73.2% and 69.65%) compared to the Mannheim Peritonitis Index (sensitivity 72.3%, specificity 68.4%) for predicting mortality in perforation peritonitis.
Why the study?
Perforation peritonitis carries high mortality if diagnosis or prognosis is delayed, and scoring systems like APACHE-II, p-POSSUM, and MPI required evaluation for their usefulness and accuracy in predicting mortality.
Do APACHE-II and p-POSSUM scoring systems improve mortality prediction compared to the Mannheim peritonitis index in patients with perforation peritonitis?
Observational (n=65)
No
Do APACHE-II and p-POSSUM scoring systems improve mortality prediction compared to the Mannheim peritonitis index in patients with perforation peritonitis?
APACHE-II and p-POSSUM scoring systems demonstrate higher sensitivity and specificity than the Mannheim Peritonitis Index for predicting in-hospital mortality in patients with perforation peritonitis.
May improve mortality prediction in perforation peritonitis; observational comparison leaves open need for prospective validation.
Background: Perforation peritonitis has emerged as one of the very common cause of surgical emergencies, particularly in developing countries like India. If left untreated for long due to improper prognosis or late diagnosis, perforation peritonitis may prove potentially fatal with a high mortality and morbidity rate. Scoring systems like APACHE-II (acute physiology and chronic health evaluation), p-POSSUM (Portsmouth-POSSUM) and MPI (Mannheim peritonitis index) may serve as simple, critical, and efficient prognostic tools in predicting the mortality in patients with perforation peritonitis. Thus, the aim of the current investigation was to examine the usefulness and accuracy of these scoring systems for predicting the mortality rate in perforation peritonitis.Methods: Current study was a prospective observational comparative study conducted at department of general surgery, KK Hospital, Lucknow. Detailed clinical and lab investigations of the participating patients were done and their demographic details were documented. Using history, clinical examination and lab values p-POSSUM, APACHE-II and MPI scores were calculated. Scores of each scoring system were statistically analyzed in prognosticating the mortality rate.Results: Mean age of the participating patients was 41.24±19.32 years. Abdominal pain and vomiting were observed as the most common symptoms in majority of patients. No mortality was observed in patients with ≤20 MPI score, ≤20 APACH-II scores and ≤55 p-POSSUM score. Whereas mortality rate was observed to be 21.53% in patients with >20 MPI score, 82% in >20 APACH-II scores and 78% in >55 p-POSSUM score.Conclusions: APACHE II and p-POSSUM scores had a higher sensitivity and specificity in comparison to MPI for predicting the mortality in perforation peritonitis.
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Kumar et al. (2022) conducted an observational in Perforation peritonitis (n=65). APACHE-II and p-POSSUM scoring systems vs. Mannheim peritonitis index (MPI) was evaluated on Mortality prediction accuracy (Sensitivity and Specificity). APACHE II and p-POSSUM scoring systems demonstrated higher sensitivity (89.2% and 85.2%) and specificity (73.2% and 69.65%) compared to the Mannheim Peritonitis Index (sensitivity 72.3%, specificity 68.4%) for predicting mortality in perforation peritonitis.
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