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: fifth postoperative day following colorectal anastomosis.
Parameters:
(1) blood loss in mL
(2) operative time in minutes
(3) intraoperative complication
(4) plasma concentration of CRP in mg/L
(5) plasma concentration of calprotectin in µg/mL
(6) absolute eosinophil count per microliter
(7) clinical condition
(8) abdominal pain severity
(9) abdominal pain at wound
(10) abdominal pain distribution
|
Parameter
|
Finding
|
Points
|
|
blood loss
|
|
0.1426 * (blood vol)
|
|
operative time
|
|
0.0041 * (time)
|
|
intraoperative complication
|
no
|
0
|
|
|
yes
|
0.7685
|
|
CRP
|
|
0.0066 * (CRP)
|
|
calprotectin
|
|
0.4548 * (calprotectin)
|
|
absolute eosinophil count
|
|
-0.0038 * (count)
|
|
clinical condition
|
improved
|
-2.199
|
|
|
not improved
|
0
|
|
abdominal pain severity
|
absent or low
|
-0.2833
|
|
|
moderate or high
|
0
|
|
pain at wound
|
no
|
0
|
|
|
yes
|
-1.5299
|
|
abdominal pain distribution
|
localized
|
1.2566
|
|
|
diffuse
|
0
|
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 > 8.29 indicates anastomotic leak.
Performance:
• Negative predictive value: 0.987
• The sensitivity is 1.00 and specificity is 0.87.
• The area under the ROC curve is 0.95.
