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: fourth postoperative day following colorectal anastomosis.
Parameters:
(1) body mass index (BMI)
(2) open surgery
(3) blood loss in mL
(4) operative time in minutes
(5) anastomosis
(6) intraoperative complication
(7) plasma concentration of CRP in mg/L
(8) plasma concentration of calprotectin in µg/mL
(9) absolute eosinophil count in cells per microliter
(10) clinical condition improved
(11) level of abdominal pain
(12) abdominal pain at wound
|
Parameter
|
Finding
|
Points
|
|
BMI
|
|
-0.02927 * (BMI)
|
|
open surgery
|
no
|
0
|
|
|
yes
|
-0.0196
|
|
blood loss
|
|
0.2044 * (blood vol)
|
|
operative time
|
|
0.0074 * (time)
|
|
anastomosis
|
colocolic
|
-0.0297
|
|
|
other
|
0
|
|
intraoperative complication
|
no
|
0
|
|
|
yes
|
1.378
|
|
CRP
|
|
0.0089 * (CRP)
|
|
calprotectin
|
|
0.1809 * (calprotectin)
|
|
absolute eosinophil count
|
|
-0.0027 * (count)
|
|
pain level
|
absent or low
|
-1.1150
|
|
|
moderate or high
|
0
|
|
pain at wound
|
no
|
0
|
|
|
yes
|
-1.845
|
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 > 2.56 indicates anastomotic leak.
Performance:
• Negative predictive value: 1.00
• The sensitivity is 1.00 and specificity is 0.70.
• The area under the ROC curve is 0.84.
