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Derivation and Validation of a Novel Physiological Emergency Surgery Acuity Score (PESAS)
Naveen F Sangji1,2, Jordan D Bohnen1, Elie P Ramly1
1Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
Background:
We present a novel and abbreviated Physiological Emergency Surgery Acuity Score (PESAS) that assesses the severity of disease at presentation in patients undergoing Emergency Surgery (ES).
Methods:
Using the 2011 ACS-NSQIP database, we identified all patients who underwent "emergent" surgery. The following methodology was designed: (1) identification of independent predictors of 30-day mortality that are markers of acuity; (2) derivation of PESAS based on the relative impact (i.e., odds ratio) of each predictor; and (3) measurement of the c-statistic. The PESAS was validated using the 2012 ACS-NSQIP database.
Results:
From 24,702 ES cases, a 15-point score was derived. This included 10 components with a range of 0 and 15 points. Its c-statistic was 0.80. Mortality gradually increased from 1.7 to 40.6 to 100% at scores of 0, 8, and 15, respectively. In the validation phase, PESAS c-statistic remained stable.
Conclusion:
PESAS is a novel score that assesses the acuity of disease at presentation in ES patients and strongly correlates with postoperative mortality risk. PESAS could prove useful for preoperative counseling and for risk-adjusted benchmarking.
