title: Validation of a score for the early diagnosis of anastomotic leakage following elective colorectal surgery.
abstract: Anastomotic leakage (AL) is the most feared complication after colorectal surgery. Its prognosis is related to early recognition and post-operative management and should be based on the concept of "failure to rescue". The aim of the present study was to validate the "DULK" diagnostic score for AL, developed in The Netherlands.
  
  
  METHODS
  From June 2012 to June 2013, 100 consecutive patients were included in a prospective study according to the post-operative care protocol developed by den Dulk et al. The score is based on several laboratory and clinical items recorded daily.
  
  
  RESULTS
  Among the 100 patients, 12 developed a post-operative AL (12%) with a specific mortality rate of 16.6% (2 patients). A DULK-score>3 was good criteria for early diagnosis of AL with a sensitivity of 91.7%, a specificity of 55.7%, a positive predictive value of 22%, a negative predictive value of 98%, and an area under the ROC curve of 0.83. If used routinely, the DULK-score would allow diagnosis of AL 3.5 days earlier than clinical judgment alone. The DULK-score was superior to common diagnostic criteria described in the literature such as the C-reactive protein or procalcitonin, in terms of both sensitivity and specificity.
  
  
  CONCLUSIONS
  The DULK-score is, at present, the most reliable instrument for early diagnosis of AL after colorectal surgery and should be integrated into risk management health policies aiming to improve the quality of care according to the "failure to rescue" concept.
authors.affiliation: Service de chirurgie digestive, CHU Estaing 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France. Electronic address: gmartin@chu-clermontferrand.fr.
authors.forename: G
authors.initials: G
authors.lastname: Martin
authors.affiliation: Service de chirurgie digestive, CHU Estaing 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
authors.forename: A
authors.initials: A
authors.lastname: Dupré
authors.affiliation: Service de chirurgie digestive, CHU Estaing 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
authors.forename: A
authors.initials: A
authors.lastname: Mulliez
authors.affiliation: Service de chirurgie digestive, CHU Estaing 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
authors.forename: F
authors.initials: F
authors.lastname: Prunel
authors.affiliation: Service de chirurgie digestive, CHU Estaing 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
authors.forename: K
authors.initials: K
authors.lastname: Slim
authors.affiliation: Service de chirurgie digestive, CHU Estaing 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
authors.forename: D
authors.initials: D
authors.lastname: Pezet
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000175:diagnosis*; D000066491:Clinical Decision-Making / Q000379:methods*; D003106:Colon / Q000601:surgery*; D003661:Decision Support Techniques; D042241:Early Diagnosis; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011182:Postoperative Care / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012007:Rectum / Q000601:surgery*; D012680:Sensitivity and Specificity
keywords: Anastomotic leakage; Colorectal surgery; Failure to rescue; Post-operative complication; Score