Prospective study using Apache II scoring to predict the outcomes of patients undergoing emergency gastrointestinal procedure
Keywords:Apache II score, Acute abdomen, ICU, Perforation peritonitis
Background: Many scoring systems have been used to assess the morbidity and mortality of patients presenting with acute abdomen, of which Apache II (acute physiology and chronic health evaluation) score has been accepted widely. This study predicted the effectiveness of Apache II scoring system as a potential clinical and research tool which could be included as routine part of patient assessment to predict the morbidity and mortality in patients undergoing emergency gastrointestinal procedures.
Methods: This study was conducted in the surgical intensive care unit of our tertiary care hospital. It was a prospective observational study done over a period of one year where we assessed the efficacy of Apache II score in eighty two patients.
Results: The Apache II scores were divided into three categories, 0-15 low risk group, 16-30 moderate risk group and 31-45 high risk group. There were 25 patients in the low risk group with all being satisfactorily discharged. With 44 patients in the moderate risk group 13 expired (29.54% mortality) and out of 13 patients in the high risk group 11 patients died (84.61% mortality).
Conclusions: In the present study the APACHE II scores have correlated well with the outcomes and ICU stay of the patient groups.
Sahu SK, Gupta A, Sachan PK, Bahl DV. Outcome of secondary peritonitis based on Apache II Score. J Surg. 2008;14:2.
Ponling GA, Sim AJW, Dudley HAF. Comparison of local and systemic of sepsis in predicting survival. Br J Surg. 1987;74(8):750-2.
Bion J. Outcome in intensive care. BMJ. 1993;307(6910):953-4.
Kanus WA, Dropper EA, Wagner DR, Zimmerman JE. APACHE severity of disease classification system. Crit Care Med. 1985;13(10):818-29.
Civelta JM, Hudson-Civeua JA, Nelson LD. Evaluation of APACHE II for cost containment and quality assurance. Ann Surg. 1990;212(3):266-74.
Ahuja A, Singh RP. Prognostic scoring indicators in evaluation of clinical outcome in intestinal perforations. J Clin Diagn Res. 2013;7(9):1953-5.
Mathur GM, Sharma R. A study of typhoid fever in Jaipur, India. Trop Geogr Med. 1971;23(4):329-34.
Huttunen R, Kairaluoma MI, Mokka RE, Larmi TK. Non-traumatic perforations of the small intestine. Surgery. 1977;81(2):184-8.
Baker SP, O’Neil B, Haddon WQ, Long WB. The injury severity score. A method for describing pattern of patients with multiple injuries and evaluating emergency cases. J Trauma. 1974;14(3):187-96.
Adesunkanmi ARK, Ajao OG. The prognostic factors in Typhoid ileal perforation. A prospective study of 50 patients. J R Coll Surg Edinb. 1997;42(6):395-9.
Bohnen J, Boulanger, Meakins JL, McLean PH. Prognosis in generalized peritonitis: relation to cause and risk factors. Arch Surg. 1983;118(3):285-90.
Jhobta RS, Attari AK, Kaushik R, Sharma R, Jhobta A. Spectrum of perforation peritonitis in India – review of 504 consecutive cases. World J Emerg Surg. 2006;1:26.
Afridi, S.P., Malik, F., Ur-Rahman, S. et al. Spectrum of perforation peritonitis in Pakistan: 300 cases Eastern experience. World J Emerg Surg 3, 31 (2008). https://doi.org/10.1186/1749-7922-3-31.
Agarwal A, Choudhary GS, Bairwa M, Choudhary A. Apache II scoring in predicting surgical outcome in patients of perforation peritonitis. Int Surg J. 2017;4(7):2321-5.