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

S Kumar,A Gupta,N Agrawal,S Chaudhary

doi:10.4314/pamj.v9i1.71197

Abstract

The 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. Data 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. 887 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. POSSUM 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.

Highlights

The 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
Ileal perforations were considered to be of typhoid origin when patient was Widal positive with one or all of the following present: 1) Acute abdomen preceded by a variable period of high non-swinging fever, abdominal pain and toxaemia; 2) Typhidot positive according to manufacturer’s instructions; 3) S. typhi isolated from blood, stool or urine cultures
Enteric fever is reported to be associated with bowel complications in later stages (3rd or 4th week); we found that EP patients presented with fever of short duration (

Summary

Introduction

The 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. 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. Conclusion: POSSUM and P-POSSUM are accurate tools for predicting morbidity and mortality respectively in EP patients. Several modifications have come in existence to more accurately predict morbidity and mortality and to include other subspecialties It can be used for risk adjustment in similar subgroups of patients in different settings so that outcome can be compared. A comparison of POSSUM and P-POSSUM scoring systems has never been done in patients with enteric perforation peritonitis

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