A simplified prognostic scoring system for peptic ulcer perforation in developing countries.
BACKGROUND
Several complex prognostic scoring systems are available for abdominal sepsis. We constructed and assessed a simplified scoring system for peptic perforation, which can be easily used in developing countries.


METHODS
One hundred and forty consecutive patients with perforated pre-pyloric or duodenal ulcer undergoing Graham's patch omentopexy closure were studied prospectively. Each factor was given a score based on its severity in accordance with the APACHE-II scoring system to construct the simplified prognostic (Jabalpur) scoring system, and multiple regression analysis was used to identify risk factors. This system was prospectively validated in the next 50 consecutive patients and compared to existing systems.


RESULTS
The factors associated with mortality were age, presence of co-morbid illness, perforation-to-operation interval, preoperative shock, heart rate, and serum creatinine. The mean score in survivors (4.9) was less than that in those who died (12.5; p<0.0001). This scoring system compared favorably with other scoring systems.


CONCLUSIONS
The Jabalpur scoring system is effective for prognostication in cases of peptic perforation. It is simple and user-friendly as it uses only six routinely documented clinical risk factors.
Mishra
Arpan
A
G I Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur, Madhya Pradesh.
Sharma
Dhananjaya
D
Raina
V K
VK
D018806:APACHE; D000328:Adult; D003906:Developing Countries; D004381:Duodenal Ulcer / Q000150:complications*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000401:mortality; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D013276:Stomach Ulcer / Q000150:complications*