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Measuring anatomic severity of disease in emergency general surgery
Shahid Shafi1, Michel Aboutanos, Carlos Vidal-Ribas Brown
1From the Institute for Health Care Research and Improvement (S.S.), Baylor Health Care System, Dallas; and Department of Trauma Service (C.V.-R.B.), University Medical Center Brackenridge, Austin, Texas; Department of Surgery (M.A.), Virginia Commonwealth University Medical Center, Richmond, Virginia; Department of Surgery (D.C), Morsani College of Medicine, University of South Florida, Tampa, Florida; Department of Surgery (M.J.C.), University of California, San Francisco; and Department of Surgery (K.I.), Keck School of Medicine of University of Southern California, Los Angeles, California; Departments of Surgery-Trauma/Critical Care and Preventive Medicine (M.L.C.), Northwestern University Feinberg School of Medicine, Chicago, Illinois; and Department of General Surgery (P.R.M., N.T.M.), Wake Forest Baptist Health, Winston-Salem, North Carolina.
Background:
Currently, there is no established system for assessing disease severity in emergency general surgery (EGS) patients. The purpose of this project was to develop a uniform grading system for measuring anatomic severity of disease in this patient population.
Methods:
The Committee on Patient Assessment and Outcomes of the American Association for the Surgery of Trauma developed a proposal by consensus of experts for grading severity of EGS diseases. It was then reviewed and approved by the Board of Managers of the American Association for the Surgery of Trauma.
Results:
A uniform grading system for measuring anatomic severity of disease in EGS is described, with specific grades for eight commonly encountered gastrointestinal conditions. These grades range from Grade I through Grade V, reflecting an escalating clinical progression from mild disease limited within the organ itself to severe disease that is widespread.
Conclusion:
This article provides a unified grading system for measuring anatomic severity of disease that is essential to advance the science of EGS. Once validated, a description of disease grade should be included in the emerging EGS registries and in research studies involving EGS patients.
