DULK is derived from DUtch LeaKage.
Patient selection: colorectal surgery with anastomosis
Parameters:
(1) fever (temperature in °C)
(2) heart rate in beats per minute
(3) respiratory rate in breaths per minute
(4) urine output
(5) mental status
(6) clinical condition
(7) signs of ileus
(8) gastric retention
(9) fascial dehiscence
(10) abdominal pain (excluding wound pain)
(11) signs of infection
(12) renal function
(13) diet
|
Parameter
|
Finding
|
Points
|
|
temperature
|
<= 38..0°C
|
0
|
|
|
> 38°C
|
1
|
|
heart rate
|
<= 100
|
0
|
|
|
> 100
|
1
|
|
respiratory rate
|
<= 30
|
0
|
|
|
> 30
|
1
|
|
urine output
|
>= 30 mL per hour
|
0
|
|
|
< 30 mL per hour
|
1
|
|
mental status
|
normal
|
0
|
|
|
agitated or lethargic
|
2
|
|
clinical condition
|
stable or improving
|
0
|
|
|
deteriorating
|
2
|
|
signs of ileus
|
no
|
0
|
|
|
yes
|
2
|
|
gastric retention
|
no
|
0
|
|
|
yes
|
2
|
|
fascial dehiscence
|
no
|
0
|
|
|
yes
|
2
|
|
abdominal pain
|
no
|
0
|
|
|
yes
|
2
|
|
signs of infection
|
no increase in WBC or CRP
|
0
|
|
|
>= 5% increase in WBC count or in CRP
|
1
|
|
renal function
|
no increase in serum urea or creatinine
|
0
|
|
|
>= 5% increase in urea or creatinine
|
1
|
|
diet
|
normal
|
0
|
|
|
tube feeding or TPN
|
0.5
|
total score = leakage score =
= SUM(points for all 13 parameters)
Interpretation:
• minimum score: 0
• maximum score: 18.5
• The worst score in a 24-hour period is used.
• A score > 4 is considered a positive test.
A modified DULK score can be used that is based on 4 factors:
(1) respiratory rate > 20 breaths per minute
(2) clinical deterioration
(3) abdominal pain other than wound pain
(4) serum CRP > 250 mg/L
