Sequential physiology scoring facilitates objective assessment of resuscitation in patients with an intra-abdominal emergency.
BACKGROUND
Patients who present with an intra-abdominal emergency often require urgent surgery. Before surgery a period of resuscitation is undertaken pre-emptively, or to correct any overt physiological derangement. The assessment of response to resuscitation and the decision when to operate is subjective. This study examined the role of sequential physiology scores in assessing the response to resuscitation objectively.


METHODS
Sequential physiology scores were recorded in 92 patients with abdominal pathology that subsequently required urgent or emergency surgery. The physiology component of the Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM), Acute Physiology And Chronic Health Evaluation (APACHE) II and III, and Simplified Acute Physiology Score (SAPS) II were determined at presentation, during resuscitation and immediately before surgery.


RESULTS
There were 76 survivors;16 patients died. All scoring systems showed an improvement during resuscitation but subsequent deterioration before surgery. The POSSUM, and APACHE II and III physiology scores differentiated more effectively between survivors and patients who died than SAPS II.


CONCLUSIONS
Sequential physiology scores may facilitate the assessment of patients' response to resuscitation. Patients who fail to respond to resuscitation when identified may benefit from more expedient surgery.
Professorial Unit of Surgery, University Hospital of North Tees, Stockton on Tees TS19 8PE, UK. gnodair@hotmail.com
G N
GN
O'Dair
D J
DJ
Leaper
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012151:Resuscitation; D012720:Severity of Illness Index; D016019:Survival Analysis