title: A new prognostic scoring system for perforation peritonitis secondary to duodenal ulcers.
abstract: OBJECTIVE
  To identify prognostic factors for perforated duodenal ulcers and to devise and assess a new scoring system.
  
  
  METHODS
  The observational prospective study was conducted at the Mayo Hospital, Lahore in two phases: from March 2010 to September 2011; and from October 2011 to July 2012. It included patients with duodenal ulcer perforation who were observed for identifying factors predicting 30-day prognosis. Each of the predictive factor was given a score based on its severity to devise a new scoring system. Chi-square was used for univariate analysis. Multivariate analysis was done using forward stepwise regression. Accuracy of the new scoring system was calculated using receiver operating curve analysis and its validity was evaluated in the second phase of the study.
  
  
  RESULTS
  Predictors of poor prognosis included multiple gut perforations, size of largest perforation >0.5cm, amount of peritoneal fluid >1000ml, simple closure, development of complications, post-operative systemic septicaemia and winter/autumn season of presentation. Overall 30-day mortality rate was 32.3% (n=32) and morbidity rate was 21.2% (n=21). The mean score was higher in the ones with poor prognosis (p=0.001). Similarly, the mean score was greater in those with grave prognosis (p=0.001). The scoring system had an overall sensitivity of 85.12% and specificity of 80.67% and was favourably comparable to other scoring systems.
  
  
  CONCLUSIONS
  The new scoring system is a useful tool in predicting 30-day prognosis for perforated duodenal ulcers in acid peptic disease.
authors.affiliation: Department of Medicine, Khan Research Laboratories Hospital, Islamabad.
authors.forename: Ali Zohair
authors.initials: AZ
authors.lastname: Nomani
authors.affiliation: West Mead Hospital, Wentworth Ville NSW 2145, Sydney, Australia.
authors.forename: Asad Khizar
authors.initials: AK
authors.lastname: Malik
authors.affiliation: Department of Medicine, Khan Research Laboratories Hospital, Islamabad.
authors.forename: Muhammad Saleem
authors.initials: MS
authors.lastname: Qureshi
mesh_terms: D000328:Adult; D019540:Area Under Curve; D004381:Duodenal Ulcer / Q000150:complications*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity