Sartelli et al reported a sepsis severity score for patients with complicated intra-abdominal infections. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple hospitals from around the world and members of the World Society of Emergency Surgery (WSES).
Patient selection: sepsis associated with complicated intra-abdominal infection (localized or diffuse peritonitis) in adults (age > 18 years)
Parameters:
(1) clinical status on admission
(2) setting of acquisition
(3) origin of intra-abdominal infection
(4) delay in source control
(5) age in years
(6) immunosuppression (chronic corticosteroids, immunosuppressant agents, chemotherapy, etc)
Parameter |
Finding |
Points |
clinical status on admission |
severe sepsis |
3 |
|
septic shock |
5 |
|
other |
0 |
setting of acquisition |
healthcare associated |
2 |
|
other |
0 |
origin of infection |
colonic non-diverticular perforation peritonitis |
2 |
|
small bowel perforation peritonitis |
3 |
|
diverticular diffuse peritonitis |
2 |
|
post-operative diffuse peritonitis |
2 |
|
other |
0 |
delay in source control |
none |
0 |
|
delayed (preoperative duration of peritonitis > 24 hours) |
3 |
age |
<= 70 years |
0 |
|
> 70 years |
2 |
immunosuppression |
no |
0 |
|
yes |
3 |
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 18
• The higher the score the more severe the patient's condition and the greater the risk of mortality.
Score |
Mortality |
0 to 3 |
0.6% |
4 to 6 |
6.3% |
7 to 18 |
42% |
9 to 18 |
56% |
11 to 18 |
68% |
13 to 18 |
81% |
Performance:
• A cutoff of 5.5 had a sensitivity of 89% and specificity of 84% for mortality. The positive likelihood ratio was 5.4.
Specialty: Infectious Diseases