Risk Stratification Tools and Scoring Systems in Perforated Viscus: A Systematic Review

Area of Science:

• Surgical Emergency Management
• Risk Stratification in Medicine

Background:

• Perforated viscus is a critical surgical emergency with high mortality rates.
• Advances in perioperative care have not eliminated the need for effective risk assessment.
• Accurate risk stratification is vital for guiding patient triage, surgical decisions, and postoperative care.

Purpose of the Study:

• To review and compare existing scoring tools for perforated viscus.
• To highlight the strengths and limitations of various risk stratification models.
• To emphasize the need for context-specific application and future hybrid models.

Main Methods:

• Review of established scoring systems: Boey score, Peptic Ulcer Perforation (PULP) score, Mannheim Peritonitis Index (MPI), Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM), and Acute Physiology and Chronic Health Evaluation II (APACHE-II).
• Analysis of the dimensions of patient risk addressed by each tool (e.g., physiological stability, intra-abdominal severity, comorbidities).
• Evaluation of the applicability of models in different clinical settings (emergency vs. tertiary centers).

Main Results:

• Simpler models (Boey, MPI) are suitable for emergency and resource-limited settings.
• More precise models (PULP, APACHE-II) integrate comorbidities and biochemical data for tertiary centers.
• POSSUM balances physiology and operative severity but may overestimate mortality.
• No single scoring tool is universally applicable.

Conclusions:

• The choice of risk stratification tool for perforated viscus depends on the clinical setting and available resources.
• Existing models have distinct advantages and limitations.
• Future research should explore hybrid scoring systems combining clinical simplicity with advanced analytics for global relevance.