Risk prediction is an important part of the management of emergency laparotomy (EL) patients. This study aims to investigate the current use of and future directions for EL risk prediction scores. New Zealand members of the Royal Australasian College of Surgery (RACS), Australian and New Zealand College of Anaesthetists (ANZCA) and College of Intensive Care Medicine (CICM) were invited to participate in an anonymous online survey. Responses were received from 316 clinicians (45 RACS, 253 ANZCA and 19 CICM), with 73% of them having >10 years' experience as a consultant. Risk assessment scores were utilised by respondents for approximately 30% of EL cases. The most common EL risk scores used were Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality (P-POSSUM) and American College of Surgeons National Surgical Quality Improvement Programs (ACS-NSQIP). When used, respondents used risk assessment mostly preoperatively (RACS 100%, ANZCA 98% and CICM 78%), although P-POSSUM and ACS-NSQIP scores require intraoperative data (which can only be estimated crudely preoperatively by the clinician). Respondents on average 'somewhat agreed' that risk assessment scores should only include preoperative variables. The most common reasons for using P-POSSUM and ACS-NSQIP scores were familiarity and ease of use and availability of online/app calculators. The most important outcomes that the respondents would like to predict were quality of life and 30-day mortality rather than long-term impact from EL. These findings suggest that developing a new score may be required to improve utilisation and help in decision-making. This may require tailoring risk scores specifically for EL, and designing them to predict what is preferred by the clinicians making the decisions.

译文

:风险预测是​​急诊剖腹手术(EL)患者管理的重要组成部分。这项研究旨在调查EL风险预测分数的当前使用和未来发展方向。澳大利亚皇家外科学院(RACS)的新西兰成员,澳大利亚和新西兰麻醉师学院(ANZCA)和重症监护医学学院(CICM)的成员参加了一项匿名的在线调查。收到316位临床医生(45位RACS,253位ANZCA和19位CICM)的答复,其中73%的顾问经验超过10年。大约30%的EL案例中,受访者使用了风险评估分数。使用的最常见的EL风险评分是朴茨茅斯死亡率列举的生理和手术严重程度评分(P-POSSUM)和美国外科医生学院国家外科手术质量改善计划(ACS-NSQIP)。在使用时,尽管P-POSSUM和ACS-NSQIP评分需要术中数据(只能由术前粗略估计),但受访者大多在术前使用风险评估(RACS 100%,ANZCA 98%和CICM 78%)。受访者平均“有点同意”风险评估分数应仅包括术前变量。使用P-POSSUM和ACS-NSQIP分数的最常见原因是熟悉度,易用性以及在线/应用程序计算器的可用性。受访者希望预测的最重要结果是生活质量和30天死亡率,而不是EL的长期影响。这些发现表明,可能需要开发新的分数以提高利用率并帮助决策。这可能需要专门针对EL量身定制风险评分,并设计它们以预测临床医生在做出决定时的偏好。

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