Accuracy of clinical prediction rules in peptic ulcer perforation: an observational study

Buck, David Levarett; Vester‐Andersen, Morten; Møller, Morten Hylander

doi:10.3109/00365521.2011.639078

Cited by 32 publications

(42 citation statements)

References 41 publications

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“…There are various studies in the literature regarding mortality prediction by the APACHE II score (13,32,36). In our study, we identified that patients who had an APACHE II score above 11 had a significantly higher mortality.…”

Section: Discussionsupporting

confidence: 59%

Risk factors influencing morbidity and mortality in perforated peptic ulcer disease

Taş

Ülger

Önder

et al. 2015

UCD

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Objective: Peptic ulcer perforation continues to be a major surgical problem. In this study, risk factors that influence morbidity and mortality in perforated peptic ulcer disease were examined. Material and Methods:Files of 148 patients who were included in the study due to peptic ulcer perforation between January 2006 and December 2010 were retrospectively analyzed. Data regarding age, gender, complaints, time elapsed between onset of symptoms and hospital admission, physical examination findings, co-morbid diseases, laboratory and imaging findings, length of hospital stay, morbidity and mortality were recorded. Results:The study group included 129 (87.2%) male and 19 (12.8%) female patients. The mean age was 51.7±20 (15-88) years. Forty five patients (30.4%) had at least one co-morbid disease. In the postoperative period, 30 patients (20.3%) had complications. The most common complication was wound infection. Mortality was observed in 27 patients (18.2%). The most common cause of mortality was sepsis. Multivariate analysis revealed age over 60 years, presence of co-morbidities and Mannheim peritonitis index as independent risk factors for morbidity. Age over 60 years, time to admission and Mannheim peritonitis index were detected as independent risk factors for mortality. Conclusion:Early diagnosis and proper treatment are important in patients presenting with peptic ulcer perforation.Key Words: Peptic ulcer perforation, morbidity, mortality, risk factors, time to admission INTRODUCTION Peptic ulcer disease (PUD) is a disease that results from an imbalance between aggressive factors such as stomach acid and pepsin and mucosa defense barriers (1). Although the need for elective surgery has decreased as a result of advances in medical treatment, 10% of the patients require surgery. The choice of treatment for peptic ulcer perforation (PUP) remains to be surgery. Currently, the most preferred surgical method is simple closure and omental plug. Different techniques are also applied (2-4). Factors that influence the prognosis of PUP are listed as follows: time to hospital presentation, large perforation diameter, age over 60 years, presence of shock, presence of concomitant diseases and localization of the perforation in the stomach (5, 6). Preoperative hemodynamic shock, sepsis and generalized peritonitis are important factors influencing morbidity and mortality (5-8). In this study, we examined the risk factors affecting morbidity and mortality in PUD. MATERIAL AND METHODSThe files of 148 patients, who were operated on at Dicle University, School of Medicine, General Surgery Clinic as diagnosed with PUD and received primary closure + omentoplasty were retrospectively examined after the obtainment of approval from Dicle University, School of Medicine, Ethics Committee with the date and number 18.07.2012/663. Written consents indicating that they allowed their data to be used in medical research were obtained from all our patients. The patients who underwent different surgical procedures or had malignant ulcer per...

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Section: Discussionsupporting

confidence: 59%

Risk factors influencing morbidity and mortality in perforated peptic ulcer disease

Taş

Ülger

Önder

et al. 2015

UCD

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“…However, prediction values of Boey scoring system were quite varying in several studies as AUC values ranged between 0, 63 to 0, 86 [5,11,12,15,24]. In our analysis we found a better Boey value (AUC: 0.92) for prediction then the reported ones.…”

Section: Discussionmentioning

confidence: 41%

A practical scoring system to predict mortality in patients with perforated peptic ulcer

Menekse

Koçer

TOPÇU³

et al. 2015

World J Emerg Surg

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IntroductionThe mortality rate of perforated peptic ulcer is still high particularly for aged patients and all the existing scoring systems to predict mortality are complicated or based on history taking which is not always reliable for elderly patients. This study’s aim was to develop an easy and applicable scoring system to predict mortality based on hospital admission data.MethodsTotal 227 patients operated for perforated peptic ulcer in two centers were included. All data that may be potential predictors with respect to hospital mortality were retrospectively analyzed.ResultsThe mortality and morbidity rates were 10.1% and 24.2%, respectively. Multivariated analysis pointed out three parameters corresponding 1 point for each which were age >65 years, albumin ≤1,5 g/dl and BUN >45 mg/dl. Its prediction rate was high with 0,931 (95% CI, 0,890 to 0,961) value of AUC. The hospital mortality rates for none, one, two and three positive results were zero, 7.1%, 34.4% and 88.9%, respectively.ConclusionBecause the new system consists only age and routinely measured two simple laboratory tests (albumin and BUN), its application is easy and prediction power is satisfactory. Verification of this new scoring system is required by large scale multicenter studies.

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“…[6,11,12,5] Buck and colleagues on the other hand expressed the meagre ability of Boey score in predicting mortality and morbidity status. [13] Their multicentre study also stated that the ASA score, and sepsis score were not able to provide convincing results in prognostication of patients. [13] Presence of comorbidities which are divergent per patient combined with increasing patient age not only makes diagnostic decisions operose but also further delays operation time thus adding on to mortality than death due to PPU in itself.…”

Section: Discussionmentioning

confidence: 99%

“…[13] Their multicentre study also stated that the ASA score, and sepsis score were not able to provide convincing results in prognostication of patients. [13] Presence of comorbidities which are divergent per patient combined with increasing patient age not only makes diagnostic decisions operose but also further delays operation time thus adding on to mortality than death due to PPU in itself. [14] Metabolic acidosis, malnutrition, hypoalbuminaemia, smoking, female gender are essential isolated risk factors in development of mortality due to PPU.…”

Section: Discussionmentioning

confidence: 99%

Frailty of Boey Score in Ppu Mortality and Morbidity Prediction- A Prospective Study

Britto¹,

Kashyap²,

Prakash³

2017

jemds

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BACKGROUNDPeptic ulcer is quite common in our country due to intake of non-steroidal anti-inflammatory drugs, alcohol, spicy diet, smoking and a stressful lifestyle. Almost everybody harbours Helicobacter pylori within them and prone to peptic ulcer. Peptic ulcer can have disastrous complications with one of them being perforation, which is a surgical emergency. Its effects can range from severe abdominal pain to hypotension, sepsis and shock. Hence, timely intervention is absolutely mandatory. Various scoring systems have been developed to prognosticate the morbidity and mortality of perforated peptic ulcer with Boey score being the most commonly followed in various healthcare setup. We tried to determine the role of Boey score in our patients with perforated peptic ulcer and analyse its limitations.

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Accuracy of clinical prediction rules in peptic ulcer perforation: an observational study

Abstract: The Boey score, the ASA score, the APACHE II score, and the sepsis score predict mortality poorly in patients with PPU.

Cited by 32 publications

References 41 publications

Risk factors influencing morbidity and mortality in perforated peptic ulcer disease

Risk factors influencing morbidity and mortality in perforated peptic ulcer disease

A practical scoring system to predict mortality in patients with perforated peptic ulcer

Frailty of Boey Score in Ppu Mortality and Morbidity Prediction- A Prospective Study

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