title: Failure of available scoring systems to predict ongoing infection in patients with abdominal sepsis after their initial emergency laparotomy.
abstract: BACKGROUND
  To examine commonly used scoring systems, designed to predict overall outcome in critically ill patients, for their ability to select patients with an abdominal sepsis that have ongoing infection needing relaparotomy.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Oddeke
authors.initials: O
authors.lastname: van Ruler
authors.forename: Jordy J S
authors.initials: JJ
authors.lastname: Kiewiet
authors.forename: Kimberley R
authors.initials: KR
authors.lastname: Boer
authors.forename: Bas
authors.initials: B
authors.lastname: Lamme
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
authors.forename: Johannes B
authors.initials: JB
authors.lastname: Reitsma
mesh_terms: D018806:APACHE; D000368:Aged; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D011379:Prognosis; D012086:Reoperation; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery