External Validation of a Decision Tool To Guide Post-Operative Management of Patients with Secondary Peritonitis

Area of Science:

• Surgical critical care
• Abdominal sepsis diagnosis
• Clinical decision support tools

Background:

• Timely identification of abdominal sepsis post-surgery for secondary peritonitis is crucial but challenging.
• A validated decision tool can aid in guiding post-operative management.
• Secondary peritonitis often results from gastrointestinal tract perforations.

Purpose of the Study:

• To validate a decision tool for identifying patients needing intervention for abdominal sepsis.
• To evaluate the tool's potential in guiding post-operative management decisions.

Main Methods:

• Prospective cohort study of adult patients with secondary peritonitis.
• Decision tool assessed using intra-operative and post-operative variables.
• Scores compared against clinical reference standards for persistent sepsis.

Main Results:

• The decision tool demonstrated fair discriminative capacity (AUC = 0.79).
• Incidence of persistent sepsis significantly differed across score categories (p < 0.001).
• Negative predictive value was 89% for low scores and 65% for intermediate scores.

Conclusions:

• The decision tool score offers fair accuracy in predicting persistent sepsis in patients post-surgery for secondary peritonitis.
• The tool's categories can potentially guide the need for diagnostic imaging.