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Severity of Illness in Intra-abdominal Infection: A Comparison of Two Indexes

Severity of Illness in Intra-abdominal Infection: A Comparison of Two Indexes Abstract • The severity of illness in 58 surgical patients with highgrade intra-abdominal infection was measured with two methods, an acute physiology score and a septic severity score. Both methods are the summed weight of derangements in physiologic factors representing the function of the major organ systems of the body. Sixteen patients died (28%). Score values with both methods were significantly higher for nonsurvivors than for survivors. There was good interrelation between the methods, and the scores correlated better with mortality than did age, chronic disease, anatomy, or cause. Three risk levels were recognized, low, high, and intermediate, with respective mortality rates of less than 10%, greater than 80%, and approximately 45%. Three-fourths of the patients were assigned to the same risk group with both methods. The severity of illness in patients with intra-abdominal infection can suitably be measured with both methods. (Arch Surg 1985;120:152-158) References 1. Pine PW, Wertz MJ, Lennard FS, et al: Determinants of organ malfunction or death in patients with intra-abdominal sepsis using discriminant analysis . Arch Surg 1983;118:242-249.Crossref 2. Bohnen J, Poulanger K, Meakins JL, et al: Prognosis in generalized peritonitis: Relation to cause and risk factors . Arch Surg 1983;110:285-290.Crossref 3. Dawson JL: A study of some factors affecting the mortality rate in diffuse peritonitis . Gut 1963;4:368-372.Crossref 4. Pitcher WD, Musher DM: Critical importance of early diagnosis and treatment of intra-abdominal infection . Arch Surg 1982;117:328-333.Crossref 5. Zer M, Dux S, Dintsman M: The timing of relaparotomy and its influence on prognosis: A ten-year survey . Am J Surg 1980;139:338-343.Crossref 6. Polk HC, Shields PC: Remote organ failure: A valid sign of occult intraabdominal infection . Surgery 1977;81:310-313. 7. Fry DF, Garrison BN, Heitsch PC, et al: Determinants of death in patients with intra-abdominal abscess . Surgery 1980;88:517-523. 8. Fry DE, Pearlstein L, Fulton RL, et al: Multiple system organ failure: The role of uncontrolled infection . Arch Surg 1980;115:136-140.Crossref 9. Siegal JH, Cerra IF, Coleman F, et al: Physiological and metabolic correlations in human sepsis . Surgery 1979;86:163-183. 10. Knaus WA, Zimmerman JP, Wagner DP, et al: APACHE: Acute physiology and chronic health evaluation: A physiologically based classification system . Crit Care Med 1981;9:591-597.Crossref 11. Stevens LE: Gauging the severity of surgical sepsis . Arch Surg 1983;118:1190-1192.Crossref 12. Elebute EA, Stoner HB: The grading of sepsis . Br J Surg 1983;70: 29-31.Crossref 13. Knaus WA, Draper FA, Wagner PP, et al: Evaluation outcome from intensive care: A preliminary multihospital comparison . Crit Care Med 1982;10:491-496.Crossref 14. Knaus WA, Le Gall JF, Wagner DP, et al: A comparison of intensive care in the USA and France . Lancet 1982;2:642-646.Crossref 15. Baker RJ, Nelder JA: The GLIM System, Release 3, Generalized Linear Interactive Modelling Manual . Rothamsted Experimental Station, Harpenden, Herts, England, 1978. 16. Meakins JL, Solomkin JS, Allo M, et al: A proposed classification of intra-abdominal infections: Stratification of etiology and risk, for future therapeutic trials. Arch Surg, in press. 17. Boey J, Wong J, Ong GP: A prospective study of operative risk factors in perforated duodenal ulcers . Ann Surg 1982;195:265-269.Crossref 18. Schwartz NZ, Tapper P, Socenberger PI: Management of perforated appendicitis in children: The controversy continues . Ann Surg 1983;197: 407-411.Crossref 19. Ferne TV, Yellen AW, Appleman MR, et al: Antibiotic management of surgically treated gangrenous or perforated appendicitis: Comparison of gentamicin and clindamycin versus cefamandole versus cefoperazone . AmJ Surg 1982;144:8-13.Crossref 20. Warshaw AL: Inflammatory masses following acute pancreatitis: Phlegmon, pseudocyst and abscess . Surg Clin North Am 1974;54:621-636. 21. Hau T, Ahrenholz DH, Simmons RL: Secondary bacterial peritonitis: The biologic basis of treatment . Curr Probl Surg 1979;16:1-65.Crossref 22. Altemeier VA, Cutbertson KB, Fullen MB, et al: Intra-abdominal abscesses . Am J Surg 1973;125:70-79.Crossref 23. Stephen M, Loewenthal J: Generalized infective peritonitis . Surg Gynecol Obstet 1978;147:231-234. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Severity of Illness in Intra-abdominal Infection: A Comparison of Two Indexes

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References (26)

Publisher
American Medical Association
Copyright
Copyright © 1985 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1985.01390260022004
Publisher site
See Article on Publisher Site

Abstract

Abstract • The severity of illness in 58 surgical patients with highgrade intra-abdominal infection was measured with two methods, an acute physiology score and a septic severity score. Both methods are the summed weight of derangements in physiologic factors representing the function of the major organ systems of the body. Sixteen patients died (28%). Score values with both methods were significantly higher for nonsurvivors than for survivors. There was good interrelation between the methods, and the scores correlated better with mortality than did age, chronic disease, anatomy, or cause. Three risk levels were recognized, low, high, and intermediate, with respective mortality rates of less than 10%, greater than 80%, and approximately 45%. Three-fourths of the patients were assigned to the same risk group with both methods. The severity of illness in patients with intra-abdominal infection can suitably be measured with both methods. (Arch Surg 1985;120:152-158) References 1. Pine PW, Wertz MJ, Lennard FS, et al: Determinants of organ malfunction or death in patients with intra-abdominal sepsis using discriminant analysis . Arch Surg 1983;118:242-249.Crossref 2. Bohnen J, Poulanger K, Meakins JL, et al: Prognosis in generalized peritonitis: Relation to cause and risk factors . Arch Surg 1983;110:285-290.Crossref 3. Dawson JL: A study of some factors affecting the mortality rate in diffuse peritonitis . Gut 1963;4:368-372.Crossref 4. Pitcher WD, Musher DM: Critical importance of early diagnosis and treatment of intra-abdominal infection . Arch Surg 1982;117:328-333.Crossref 5. Zer M, Dux S, Dintsman M: The timing of relaparotomy and its influence on prognosis: A ten-year survey . Am J Surg 1980;139:338-343.Crossref 6. Polk HC, Shields PC: Remote organ failure: A valid sign of occult intraabdominal infection . Surgery 1977;81:310-313. 7. Fry DF, Garrison BN, Heitsch PC, et al: Determinants of death in patients with intra-abdominal abscess . Surgery 1980;88:517-523. 8. Fry DE, Pearlstein L, Fulton RL, et al: Multiple system organ failure: The role of uncontrolled infection . Arch Surg 1980;115:136-140.Crossref 9. Siegal JH, Cerra IF, Coleman F, et al: Physiological and metabolic correlations in human sepsis . Surgery 1979;86:163-183. 10. Knaus WA, Zimmerman JP, Wagner DP, et al: APACHE: Acute physiology and chronic health evaluation: A physiologically based classification system . Crit Care Med 1981;9:591-597.Crossref 11. Stevens LE: Gauging the severity of surgical sepsis . Arch Surg 1983;118:1190-1192.Crossref 12. Elebute EA, Stoner HB: The grading of sepsis . Br J Surg 1983;70: 29-31.Crossref 13. Knaus WA, Draper FA, Wagner PP, et al: Evaluation outcome from intensive care: A preliminary multihospital comparison . Crit Care Med 1982;10:491-496.Crossref 14. Knaus WA, Le Gall JF, Wagner DP, et al: A comparison of intensive care in the USA and France . Lancet 1982;2:642-646.Crossref 15. Baker RJ, Nelder JA: The GLIM System, Release 3, Generalized Linear Interactive Modelling Manual . Rothamsted Experimental Station, Harpenden, Herts, England, 1978. 16. Meakins JL, Solomkin JS, Allo M, et al: A proposed classification of intra-abdominal infections: Stratification of etiology and risk, for future therapeutic trials. Arch Surg, in press. 17. Boey J, Wong J, Ong GP: A prospective study of operative risk factors in perforated duodenal ulcers . Ann Surg 1982;195:265-269.Crossref 18. Schwartz NZ, Tapper P, Socenberger PI: Management of perforated appendicitis in children: The controversy continues . Ann Surg 1983;197: 407-411.Crossref 19. Ferne TV, Yellen AW, Appleman MR, et al: Antibiotic management of surgically treated gangrenous or perforated appendicitis: Comparison of gentamicin and clindamycin versus cefamandole versus cefoperazone . AmJ Surg 1982;144:8-13.Crossref 20. Warshaw AL: Inflammatory masses following acute pancreatitis: Phlegmon, pseudocyst and abscess . Surg Clin North Am 1974;54:621-636. 21. Hau T, Ahrenholz DH, Simmons RL: Secondary bacterial peritonitis: The biologic basis of treatment . Curr Probl Surg 1979;16:1-65.Crossref 22. Altemeier VA, Cutbertson KB, Fullen MB, et al: Intra-abdominal abscesses . Am J Surg 1973;125:70-79.Crossref 23. Stephen M, Loewenthal J: Generalized infective peritonitis . Surg Gynecol Obstet 1978;147:231-234.

Journal

Archives of SurgeryAmerican Medical Association

Published: Feb 1, 1985

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