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Arterial pH and arterial oxygenation are not essential for risk stratification in perforation peritonitis
Background:
The Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system is widely used for assessing the severity of disease and prognostication in cases of perforation peritonitis. Investigations like arterial pH and oxygenation (PaO2), which are considered important in APACHE II, are not available in most hospitals. We therefore attempted to validate a modified APACHE II (without arterial pH and oxygenation) in cases of perforation peritonitis.
Methods:
Fifty consecutive patients with perforation peritonitis admitted in the general surgical ward were prospectively analyzed vis-a-vis risk factors and mortality according to the modified APACHE II.
Results:
The mean modified APACHE II score of those who died was 15.3 (SD 5.7) as compared to 6.6 (4.7) (p < 0.001) in those who survived. As the score increased, mortality rate rose (p < 0.001). When the score was greater than 15, mortality was 88.9%; there was 100% mortality with score greater than 17.
Conclusion:
The modified APACHE II, excluding arterial pH and oxygenation, is simplified, reliable and objective for prediction of outcome in perforation peritonitis.