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Acute generalized peritonitis in African children: assessment of severity of illness using modified APACHE II score
A R K Adesunkanmi1, S A Oseni, O Adejuyigbe
1Departments of Surgery and Paediatrics, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria. adesunkanmi@yahoo.com
Insights
A modified APACHE II score effectively predicts mortality in pediatric surgical acute abdomen cases. Scores over 15 significantly correlate with higher mortality rates, aiding in prioritizing treatment for critically ill children.
Area of Science:
- Pediatric Surgery
- Critical Care Medicine
- Medical Scoring Systems
Background:
- Generalized surgical acute abdomen is a critical condition in children, leading to significant morbidity and mortality.
- Accurate severity assessment is crucial for effective treatment prioritization and complication reduction.
- High severity scores in pediatric acute abdomen patients indicate a greater risk of adverse outcomes and necessitate intensive care.
Purpose of the Study:
- To evaluate the utility of a modified Acute Physiological and Chronic Ill-health Evaluation II (APACHE II) score for assessing the severity of generalized surgical acute abdomen in pediatric patients.
- To determine the correlation between modified APACHE II scores and patient outcomes, specifically mortality.
Main Methods:
- A prospective study of 69 children operated on for generalized acute abdomen between January 1993 and December 1999.
- Data collection included demographic, clinical, and operative details, with severity assessed using a modified APACHE II scoring system.
- Comparison of modified APACHE II scores with postoperative outcomes, including mortality, to identify predictive value.
Main Results:
- Typhoid intestinal perforation (50.7%) and intestinal obstruction (13%) were the most common diagnoses.
- The modified APACHE II score ranged from 0 to 18 (mean 8.5).
- A significantly higher mortality rate (66.7%) was observed in patients with scores of 16-18 compared to those with scores of 0-15 (6.4%), with scores >15 indicating greater mortality risk.
Conclusions:
- A modified APACHE II score can be effectively applied to predict mortality in children suffering from generalized peritonitis.
- Further validation with larger patient cohorts is recommended to confirm the findings and refine the scoring system's application in pediatric critical care.
Background:
Generalized surgical acute abdomen is a significant cause of morbidity and mortality among children. Severity assessment is useful in order to prioritize treatment and reduce complications. Patients with a high severity score are often faced with high morbidity and mortality, thus, requiring more intensive treatment than those with low severity scores. The purpose of the present study was to assess the severity of the acute abdomen in paediatric patients using a modification of the acute physiological and chronic ill-health evaluation II score (APACHE II).
Methods:
Children admitted and operated on for generalized acute abdomen over a period of 7 years from January 1993 to December 1999 were prospectively studied. A study proforma was drafted and demographic, clinical, preoperative, operative and postoperative data on each patient were entered. Each patient had severity of illness assessed using APACHE II parameters with minor modification to make it applicable to children. Postoperative outcome and severity of illness were compared to determine any correlation.
Results:
There were 69 patients operated on within the period of the study. Age ranged from 3 months to 15 years, with a mean of 9.1 SD 4.3 years. Forty-two patients (61.2%) were male and 27 (39.8%) were female. Typhoid intestinal perforation accounted for 35 (50.7%) and intestinal obstruction with or without intestinal gangrene accounted for nine (13%). Modified APACHE II score ranged from 0 to 18, mean 8.5 SD 5. For survivors, the mean score was 8; for non-survivors, 13. Eight patients died (11.6%): four of 63 (6.4%) patients who scored 0-15 died; four of six (66.7%) patients who scored 16-18 (P < 00.05) died. A modified APACHE II score greater than 15 was associated with a significantly greater mortality. The data for postoperative morbidity and hospital stay were not conclusive.
Conclusion:
Although the APACHE II score was designed for adults, a modification can be suitably applied to predict mortality in children with generalized peritonitis. There will be a need to apply this to large number of patients in order to validate our finding.