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J Korean Soc Emerg Med > Volume 33(2); 2022 > Article
Journal of The Korean Society of Emergency Medicine 2022;33(2): 193-202.
응급실로 내원한 비외상성 복막염 환자의 위험 예측 모델로서 P-POSSUM 및 맨하임 복막염 지수(Mannheim Peritonitis Index) 평가를 위한 단일 응급센터 연구
김보람1 , 김성훈2 , 최마이클승필1 , 최대해1 , 제동욱1 , 노우영1 , 이수형1 , 조선호1 , 김신우1 , 김형욱1 , 이정식1
1차의과학대학교 구미차병원 응급의학과
2울산병원 응급의학과
A single emergency center study for evaluation of P-POSSUM and Mannheim Peritonitis Index as a risk prediction model in patients with non-traumatic peritonitis
Boram Kim1 , Seong Hun Kim2 , Sung Pil Michael Choe1 , Daihai Choi1 , Dong Wook Je1 , Woo Young Nho1 , Soo Hyung Lee1 , Sunho Cho1 , Shinwoo Kim1 , Hyoungouk Kim1 , Jeong Sik Yi1
1Department of Emergency Medicine, CHA Gumi Medical Center, CHA University, Gumi, Korea
2Department of Emergency Medicine, Ulsan Medical Center, Ulsan, Korea
Correspondence  Jeong Sik Yi ,Tel: 054-450-9936, Fax: 054-450-9967, Email: dallmuli@naver.com,
Received: July 6, 2021; Revised: September 24, 2021   Accepted: September 29, 2021.  Published online: April 30, 2022.
Peritonitis is a life-threatening, emergent surgical disease with very high mortality and morbidity. Currently, there are insufficient Korean studies using the P-POSSUM (Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) and the Mannheim Peritonitis Index (MPI) as risk prediction models for nontraumatic peritonitis patients who visit the emergency room.
This retrospective study was carried out on 196 cases of non-traumatic peritonitis in a single emergency center from January 2015 to December 2019. Receiver operating characteristic (ROC) curves were obtained and the area under the ROC curve (AUC) was compared using both P-POSSUM and MPI. The observed mortality and expected mortality for P-POSSUM were compared using the goodness of fit assessed using the Hosmer-Lemeshow equation.
Diastolic blood pressure, blood urea nitrogen, potassium, length of stay, and intensive care unit admissions were significantly different between survivors and non-survivors. The AUC was 0.812 for P-POSSUM and 0.646 for MPI. The observed-to-expected mortality ratio for P-POSSUM indicated fewer than expected deaths in all quintiles of risk and this was more pronounced, especially when the expected mortality was over 60%.
In non-traumatic peritonitis patients, P-POSSUM was more useful in predicting risk than the MPI score. However, P-POSSUM overestimated the risk in high-risk patients. Although the MPI score is only somewhat useful for predicting mortality in patients with non-traumatic peritonitis, it is useful as an adjuvant.
Key words: Peritonitis; Risk assessment; Mortality
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