Validation of modified possum scoring system in perforative peritonitis

Ambarish, Chatterjee (2014) Validation of modified possum scoring system in perforative peritonitis. Masters thesis, Coimbatore Medical College, Coimbatore.


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BACKGROUND AND OBJECTIVES: Perforative peritonitis carries considerable morbidity and mortality. Even if patients reach the hospital at the earliest, still the post operative period is unpredictable most of the times. It therefore becomes necessary for a scoring system that predicts the post-operative period. POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) helps in predicting the post-operative morbidity and mortality in these patients. POSSUM scores are calculated on the basis of 12 physiological factors and 6 operative factors. In our study we have included two more factors which are specifically important in perforative peritonitis. These two factors are the perforation to operation time, which is the time duration between the occurrence of perforation and operation; and the presence of co-morbidity. The presence of these factors significantly affects the post-operative status of the patients. Through this prospective study we can predict which patients are at a higher risk of death or complication and give appropriate management as necessary. METHODS: In this study, the sample size was 50 patients admitted in Coimbatore Medical College and Hospital, who are diagnosed with peritonitis due to hollow viscus perforation. Data was collected based on factors of POSSUM scoring system. Outcome of the patients was recorded as death / alive; complicated / uncomplicated and statistical analysis was done by comparing the expected and observed outcomes. RESULTS: By applying linear analysis, an observed to expected ratio of 1.005 was obtained for mortality rate and 1.001 for morbidity rate. There was no statistical significant difference between the observed and expected mortality rates (χ2 = 3.54, p = 0.316) and morbidity rates (χ2 = 2.40, p = 0.792). It was found to be comparable to other studies. Two factors were independently studied; perforation to operation time and presence of co-morbidity. A statistical significance was established between these two variables and the outcome. (p<0.05) INTERPRETATION AND CONCLUSION: POSSUM scoring system is a good indicator of post operative outcome in surgeries performed for perforative peritonitis and was applicable in our setup. It may be used in identify high risk patients and give preferential care to these patients for better outcome. Inclusion of factors like perforation to operation time and co-morbid status can improve the scoring system. Hence a modification in the scoring system according to the surgery will more improve the outcome of the patients and better care can be provided to them.

Item Type: Thesis (Masters)
Uncontrolled Keywords: POSSUM ; perforative peritonitis ; perforation to operation time ; co-morbidity.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 24 Jun 2018 18:13
Last Modified: 24 Jun 2018 18:13

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