Prospective evaluation of prognostic scoring systems in peritonitis. Peritonitis Study Group

Abstract

Objective: To assess the accuracy of the APACHE II score, the Mannheim Peritonitis Index (MPI), and the Peritonitis Index Altona (PIA) II in the prediction of outcome of patients with peritonitis.

Design: Prospective, multicentre study.

Setting: 12 Departments of Surgery in Europe.

Subjects: 271 Patients with peritonitis confirmed at laparatomy.

Interventions: Computation of the three scores on one set of data for each patient.

Main outcome measures: The ability to predict death or survival within 30 days of operation with each of the three scores. The prediction were evaluated according to the following criteria: discriminatory ability (areas under the receiver-operator characteristic (ROC) curves relating sensitivity to specificity); sharpness (level of confidence that was associated with a prediction); and reliability (agreement between predicted and observed mortality within equidistant intervals on the scale).

Results: APACHE II was superior to both the MPI and PIA II in its discriminatory ability and reliability, but the MPI and PIA II made more "sharp" predictions.

Conclusions: None of the three scores is of any use for predicting the outcome for individual patients. APACHE II is the current standard for assessing the severity of peritonitis.