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Scoring systems for outcome prediction in patients with perforated peptic ulcer
Kenneth Thorsen1, Jon Arne Søreide, Kjetil Søreide
1Department of Gastrointestinal Surgery, Stavanger University Hospital, POB 8100, Stavanger, N, 4068, Norway.
Insights
This review found that while Boey and ASA scores are common for perforated peptic ulcer (PPU) patients, their accuracy varies significantly. The Peptic Ulcer Perforation (PULP) score shows promise but requires further validation for clinical use.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Medical Informatics
Background:
- Perforated peptic ulcer (PPU) is a severe condition with high morbidity and mortality rates.
- Existing prognostic scoring systems for PPU patients lack consistent validation and applicability.
- Effective outcome prediction is crucial for managing PPU patients.
Purpose of the Study:
- To systematically review and compare available scoring systems for predicting outcomes in perforated peptic ulcer patients.
- To identify if evidence supports preferring one scoring system over others for PPU management.
Main Methods:
- A comprehensive PubMed search was conducted using keywords related to perforated peptic ulcer and scoring systems.
- Studies published between January 2000 and December 2012 were included, focusing on outcome prediction for PPU.
- Identified scoring systems were analyzed for their construction and performance evaluation using receiver operating characteristic (ROC) curve analysis.
Main Results:
- Ten distinct scoring systems were identified, with only four specifically designed for PPU.
- Performance evaluation via Area Under the Curve (AUC) showed significant variability, ranging from 0.63 to 0.98.
- Commonly used scores like Boey and ASA demonstrated inconsistent accuracy in outcome prediction.
Conclusions:
- The Boey score and ASA score are frequently used but exhibit variable predictive accuracy for PPU outcomes.
- Many scoring systems are limited by insufficient validation or clinical complexity.
- The Peptic Ulcer Perforation (PULP) score is a promising tool but requires external validation prior to widespread adoption.
Background:
Patients with perforated peptic ulcer (PPU) often present with acute, severe illness that carries a high risk for morbidity and mortality. Mortality ranges from 3-40% and several prognostic scoring systems have been suggested. The aim of this study was to review the available scoring systems for PPU patients, and to assert if there is evidence to prefer one to the other.
Material And Methods:
We searched PubMed for the mesh terms "perforated peptic ulcer", "scoring systems", "risk factors", "outcome prediction", "mortality", "morbidity" and the combinations of these terms. In addition to relevant scores introduced in the past (e.g. Boey score), we included recent studies published between January 2000 and December 2012) that reported on scoring systems for prediction of morbidity and mortality in PPU patients.
Results:
A total of ten different scoring systems used to predict outcome in PPU patients were identified; the Boey score, the Hacettepe score, the Jabalpur score the peptic ulcer perforation (PULP) score, the ASA score, the Charlson comorbidity index, the sepsis score, the Mannheim Peritonitis Index (MPI), the Acute physiology and chronic health evaluation II (APACHE II), the simplified acute physiology score II (SAPS II), the Mortality probability models II (MPM II), the Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity physical sub-score (POSSUM-phys score). Only four of the scores were specifically constructed for PPU patients. In five studies the accuracy of outcome prediction of different scoring systems was evaluated by receiver operating characteristics curve (ROC) analysis, and the corresponding area under the curve (AUC) among studies compared. Considerable variation in performance both between different scores and between different studies was found, with the lowest and highest AUC reported between 0.63 and 0.98, respectively.
Conclusion:
While the Boey score and the ASA score are most commonly used to predict outcome for PPU patients, considerable variations in accuracy for outcome prediction were shown. Other scoring systems are hampered by a lack of validation or by their complexity that precludes routine clinical use. While the PULP score seems promising it needs external validation before widespread use.
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