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Published on: October 16, 2013
[The Mannheim Peritonitis Index cannot be routinely used to guide surgical decision-making for peritonitis]
T V Nechay1, A E Tyagunov1, A S Li1
1Pirogov Russian National Research Medical University, Moscow, Russia.
Objective:
To evaluate the evidence base of the Mannheim Peritonitis Index (MPI) for choice of relaparotomy (programmed vs on-demand) in severe peritonitis.
Material And Methods:
The study was carried out in 3 stages.
None:
1. MPI-based assessment of evidence base of national guidelines «Peritonitis» regarding the choice of relaparotomy (programmed vs on-demand).
None:
2. Statements and recommendations of current foreign guidelines on MPI-based choice of tactics for peritonitis.
None:
3. Systematic review of evidence base of studies that used MPI to determine surgical tactics.
Results:
The studies listed in national guidelines do not provide evidence of feasibility of MPI as a tool for determining tactics. This index is not mentioned in 3 out of 7 foreign recommendations on abdominal surgical infection. In other recommendations with moderate level of recommendations and low level of evidence, MPI is indicated as a tool for predicting mortality. In 7 retrospective studies not included in recommendations, there was no evidence for advisability of MPI to determine surgical tactics.
Conclusion:
There is currently no evidence base for MPI in choosing programmed or on-demand relaparotomy in case of severe peritonitis. Further high-evidence studies are required to find significant criteria.
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