Rama et al reported the E-CRALL score to provide early warning of an anastomotic leak after colorectal surgery. This can help to identify a patient at increased risk sooner. The authors are from Leiria Hospital in Portugal.
E-CRALL = early colorectal leakage score
Patient selection: third postoperative day following colorectal anastomosis.
Parameters:
(1) body mass index (BMI)
(2) Charlson comorbidity index (CCI)
(3) ASA score
(4) blood loss in mL
(5) operative time in minutes
(6) anastomosis
(7) intraoperative complication
(8) plasma concentration of CRP in mg/L
(9) plasma concentration of calprotectin in µg/mL
(10) abdominal pain at wound
|
Parameter
|
Finding
|
Points
|
|
BMI
|
|
-0.05142 * (BMI)
|
|
Charlson comorbidity
|
|
0.1403 * (CCI)
|
|
ASA score
|
1 or 2
|
0
|
|
|
3 or 4
|
0.0764
|
|
blood loss
|
|
0.2418 * (blood vol)
|
|
operative time
|
|
0.007 * (time)
|
|
anastomosis
|
colocolic
|
-0.1065
|
|
|
other
|
0
|
|
intraoperative complication
|
no
|
0
|
|
|
yes
|
1.1731
|
|
CRP
|
|
0.0099 * (CRP)
|
|
calprotectin
|
|
0.1333 * (calprotectin)
|
|
pain at wound
|
no
|
0
|
|
|
yes
|
-1.19011
|
where:
• The mean blood loss was 51.6 mL in Group 1, 58.5 in Group 2, and 104 in Group 3. The score is very sensitive to blood loss.
total score =
= SUM(points for all of the parameters)
Interpretation:
• A score > 5.51 indicates anastomotic leak.
Performance:
• Negative predictive value: 0.987
• The sensitivity is 0.86 and specificity is 0.66.
• The area under the ROC curve is 0.82.
