title: Derivation and Validation of a Novel Physiological Emergency Surgery Acuity Score (PESAS).
abstract: We present a novel and abbreviated Physiological Emergency Surgery Acuity Score (PESAS) that assesses the severity of disease at presentation in patients undergoing Emergency Surgery (ES).
  
  
  
  Using the 2011 ACS-NSQIP database, we identified all patients who underwent "emergent" surgery. The following methodology was designed: (1) identification of independent predictors of 30-day mortality that are markers of acuity; (2) derivation of PESAS based on the relative impact (i.e., odds ratio) of each predictor; and (3) measurement of the c-statistic. The PESAS was validated using the 2012 ACS-NSQIP database.
  
  
  
  From 24,702 ES cases, a 15-point score was derived. This included 10 components with a range of 0 and 15 points. Its c-statistic was 0.80. Mortality gradually increased from 1.7 to 40.6 to 100% at scores of 0, 8, and 15, respectively. In the validation phase, PESAS c-statistic remained stable.
  
  
  
  PESAS is a novel score that assesses the acuity of disease at presentation in ES patients and strongly correlates with postoperative mortality risk. PESAS could prove useful for preoperative counseling and for risk-adjusted benchmarking.
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.|Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Naveen F
authors.initials: NF
authors.lastname: Sangji
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
authors.forename: Jordan D
authors.initials: JD
authors.lastname: Bohnen
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
authors.forename: Elie P
authors.initials: EP
authors.lastname: Ramly
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
authors.affiliation: Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA. hkaafarani@mgh.harvard.edu.|Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA. hkaafarani@mgh.harvard.edu.
authors.forename: Haytham M A
authors.initials: HMA
authors.lastname: Kaafarani
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D004630:Emergencies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012720:Severity of Illness Index; D013514:Surgical Procedures, Operative / Q000401:mortality*