Typhoid Intestinal Perforation Prognostic Score in Poor-Resource Settings

Area of Science:

• Tropical Medicine
• Surgical Outcomes
• Public Health in Africa

Background:

• High mortality rates from peritonitis due to typhoid intestinal perforation (TIP) are a significant concern in sub-Saharan Africa.
• Typhoid fever remains a prevalent infectious disease in low-resource settings, frequently leading to intestinal complications.

Purpose of the Study:

• To identify predictive factors for mortality in patients with TIP.
• To develop and validate a prognostic scoring system (TIPPS) for TIP.
• To inform appropriate surgical management strategies for TIP in resource-limited environments.

Main Methods:

• Retrospective data collection of TIP-related peritonitis cases at Zinder National Hospital (2014-2021).
• Development of the Typhoid Intestinal Perforation Prognostic Score (TIPPS) using a score-building group and validation in a separate group.
• Univariate and multivariate analyses to determine mortality risk factors, with P < 0.05 considered significant.

Main Results:

• TIP accounted for over 52% of peritonitis cases, with a median age of 12 years and predominantly rural provenance.
• Key mortality predictors included elevated respiratory rate, low systolic blood pressure, elevated serum creatinine, low hemoglobin, comorbidities, high ASA score, delayed management (>72h), and multiple perforations.
• The developed TIPPS (8-20) demonstrated good performance (AUROC > 0.83) in predicting mortality, with risk increasing with higher scores, leading to a four-grade classification (I-IV).

Conclusions:

• The TIPPS is a simple yet effective tool for assessing TIP severity and predicting mortality risk.
• The study underscores the critical importance of timely and adequate perioperative resuscitation for improving outcomes in complicated TIP cases.