Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review

Oliver, C.M., Walker, E., Giannaris, S., Grocott, M.P.W. and Moonesinghe, S.R. (2015) Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review British Journal of Anaesthesia (doi:10.1093/bja/aev350). (PMID:26537629).


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Emergency laparotomies are performed commonly throughout the world, but one in six patients die within a month of surgery. Current international initiatives to reduce the considerable associated morbidity and mortality are founded upon delivering individualised perioperative care. However, while the identification of high-risk patients requires the routine assessment of individual risk, no method of doing so has been demonstrated to be practical and reliable across the commonly encountered spectrum of presentations, co-morbidities and operative procedures. A systematic review of Embase and Medline identified 20 validation studies assessing 25 risk assessment tools in patients undergoing emergency laparotomy. The most frequently studied general tools were APACHE II, ASA-PS and P-POSSUM. Comparative, quantitative analysis of tool performance was not feasible due to the heterogeneity of study design, poor reporting and infrequent within-study statistical comparison of tool performance. Reporting of calibration was notably absent in many prognostic tool validation studies. APACHE II demonstrated the most consistent discrimination of individual outcome across a variety of patient groups undergoing emergency laparotomy when used either preoperatively or postoperatively (area under the curve 0.76-0.98). While APACHE systems were designed for use in critical care, the ability of APACHE II to generate individual risk estimates from objective, exclusively preoperative data items may lead to better-informed shared decisions, triage and perioperative management of patients undergoing emergency laparotomy. Future endeavours should include the recalibration of APACHE II and P-POSSUM in contemporary cohorts, modifications to enable prediction of morbidity and assessment of the impact of adoption of these tools on clinical practice and patient outcomes.

Item Type: Article
Digital Object Identifier (DOI): doi:10.1093/bja/aev350
ISSNs: 0007-0912 (print)
Keywords: emergency laparotomy, postoperative mortality, prognostic tool, risk adjustment, risk assessment
Subjects: R Medicine > RC Internal medicine
Organisations: Clinical & Experimental Sciences
ePrint ID: 384069
Date :
Date Event
3 November 2015Published
Date Deposited: 09 Dec 2015 16:58
Last Modified: 17 Apr 2017 04:48
Further Information:Google Scholar
URI: http://eprints.soton.ac.uk/id/eprint/384069

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