%0 Journal Article
%T Failure of available scoring systems to predict ongoing infection in patients with abdominal sepsis after their initial emergency laparotomy
%A Oddeke van Ruler
%A Jordy JS Kiewiet
%A Kimberley R Boer
%A Bas Lamme
%A Dirk J Gouma
%A Marja A Boermeester
%A Johannes B Reitsma
%J BMC Surgery
%D 2011
%I BioMed Central
%R 10.1186/1471-2482-11-38
%X Data from a RCT comparing two surgical strategies was used. The study population consisted of 221 patients at risk for ongoing abdominal infection. The following scoring systems were evaluated with logistic regression analysis for their ability to select patients requiring a relaparotomy: APACHE-II score, SAPS-II, Mannheim Peritonitis Index (MPI), MODS, SOFA score, and the acute part of the APACHE-II score (APS).The proportion of patients requiring a relaparotomy was 32% (71/221). Only 2 scores had a discriminatory ability in identifying patients with ongoing infection needing relaparotomy above chance: the APS on day 1 (AUC 0.61; 95%CI 0.52-0.69) and the SOFA score on day 2 (AUC 0.60; 95%CI 0.52-0.69). However, to correctly identify 90% of all patients needing a relaparotomy would require such a low cut-off value that around 80% of all patients identified by these scoring systems would have negative findings at relaparotomy.None of the widely-used scoring systems to predict overall outcome in critically ill patients are of clinical value for the identification of patients with ongoing infection needing relaparotomy. There is a need to develop more specific tools to assist physicians in their daily monitoring and selection of these patients after the initial emergency laparotomy.ISRCTN: ISRCTN 51729393Our group conducted a trial among patients with abdominal sepsis comparing on-demand versus planned relaparotomy after the initial emergency operation (RELAP trial) [1]. We concluded that the on-demand strategy should be preferred, based on comparable clinical outcomes (12-month mortality 29% vs. 36%; P = 0.22), but a substantial reduction of healthcare utilization and costs [1]. Planned relaparotomy yielded negative findings in 66% of patients and, thus, had no therapeutic effect in these patients. Improvement of patient selection for relaparotomy in the on-demand strategy however is necessary as 31% of these patients also had a negative relaparotomy [1].The on-demand
%U http://www.biomedcentral.com/1471-2482/11/38