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Risk stratification tools in emergency general surgery.

Joaquim Michael Havens1,2, Alexandra B Columbus2, Anupamaa J Seshadri1

  • 1Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.

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Summary

Risk stratification tools (RST) help guide decisions in medicine. For emergency general surgery (EGS), the Emergency Surgery Acuity Score and ACS NSQIP USRC are most suitable for assessing patient risk.

Keywords:
emergency general surgeryrisk adjustment

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Area of Science:

  • Surgical Outcomes Research
  • Patient Risk Assessment
  • Emergency Medicine

Background:

  • Risk stratification tools (RST) are vital for clinical decision-making across medical fields.
  • Emergency general surgery (EGS) patients present unique challenges due to high acuity and comorbidities, leading to significant perioperative risks.
  • Existing RST have not been extensively validated for the specific EGS population.

Purpose of the Study:

  • To identify a comprehensive risk stratification tool for EGS patients.
  • The ideal tool should accurately predict perioperative mortality and complications.
  • The tool must balance individualized patient assessment with practical usability.

Main Methods:

  • A review of existing risk stratification systems was conducted.
  • Systems evaluated included Trauma Scoring Systems, Critical Care Scoring Systems, Surgical Scoring Systems, and Track and Trigger Models.
  • Applicability to the EGS patient population was the primary assessment criterion.

Main Results:

  • Several categories of RST were reviewed for their suitability in EGS.
  • The Emergency Surgery Acuity Score (ESAS) emerged as a relevant tool.
  • The American College of Surgeons National Surgical Quality Improvement Programme Universal Surgical Risk Calculator (ACS NSQIP USRC) was also identified as highly applicable.

Conclusions:

  • The ESAS and ACS NSQIP USRC are the most appropriate RST for EGS.
  • These tools offer a comprehensive approach to assessing perioperative risk in EGS patients.
  • Further validation and implementation of these tools can improve EGS patient care and outcomes.