Delays in performing emergency surgery in elderly lead to higher complication rates. Obtaining CT scans early also may facilitate prompt diagnosis of certain abdominal emergencies where presentation is more equivocal and this may lead to improved surgical outcomes.

Background (aims, hypotheses, or objectives) Emergency laparotomy (EL) is a high‐risk surgical procedure associated with considerable morbidity and mortality around the world. A reliable risk‐assessment tool that is specific to patients undergoing EL allows the early identification of high‐risk patients and enables appropriate healthcare resource allocation. The objective of this study was to compare the commonly used Portsmouth‐physiologic and operative severity score for the enumeration of mortality and morbidity (P‐POSSUM) with the recently developed National Emergency Laparotomy Audit (NELA) score in terms of their accuracy for identifying patients at increased risk of 30‐day mortality in a predominantly Asian population. Methods Physiological and operative data from a prospectively collected audit of adult patients undergoing EL in 2018 and 2019 across two tertiary hospitals in Singapore were used to retrospectively calculate both the P‐POSSUM and NELA scores for each patient encounter. This was then compared to actual mortality rates to determine each model's accuracy and precision. Results 830 patients were included in the study with a 30‐day mortality of 5.66%. The area under the receiver operating characteristics curve (AUROC) was similar for both the NELA (0.86, p < 0.001, 95% CI 0.81–0.91) and the P‐POSSUM models (0.84, p < 0.001, 95% CI 0.78–0.89). While the models over‐predicted mortality, overall O:E ratios showed that the NELA model performance was superior to that of P‐POSSUM (0.58 [95% CI 0.43–0.77] compared to 0.34 [95% CI 0.26–0.46]). Conclusion The NELA risk‐prediction model accurately predicts 30‐day mortality in this large cohort of patients undergoing EL and outperforms the current P‐POSSUM model. We recommend that the NELA score should replace the P‐POSSUM score as a model to distinguish between high‐ and low‐risk patients undergoing EL.

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Intercostal artery bleeding from trauma can result in potentially fatal massive hemothorax. Traumatic hemothorax has traditionally been treated with tube thoracostomy, video-assisted thoracoscopic surgery, or thoracotomy. Transcatheter arterial embolization (TAE), a well-established treatment option for a variety of acute hemorrhage is not widely practiced for the management of traumatic hemothorax. We present 2 cases of delayed massive hemothorax following chest trauma which were successfully managed by transarterial embolization of intercostal arteries. The published studies are reviewed and a systematic approach to the selection of patients for TAE versus emergency thoracotomy is proposed.