Sangji et al reported the Physiological Emergency Surgery Acuity Score (PESAS). This can help to predict the risk of mortality following emergency surgery. The authors are from Massachusetts General Hospital and Harvard University.
Patient selection: emergency surgery
Parameters:
(1) serum albumin in g/dL
(2) serum alkaline phosphatase in U/L
(3) serum blood urea nitrogen (BUN) in mg/dL
(4) serum creatinine in mg/dL
(5) INR
(6) platelet count per microliter
(7) serum SGOT in U/L
(8) serum sodium in mmol/L
(9) ventilator requirement within the 48 hours prior to surgery
(10) white blood cell (WBC) count per microliter
|
Parameter
|
Finding
|
Points
|
|
serum albumin
|
>= 3.0 g/dL
|
0
|
|
|
< 3.0 g/dL
|
1
|
|
serum alkaline phosphatase
|
<= 125 U/L
|
0
|
|
|
> 125 U/L
|
1
|
|
serum BUN
|
<= 40 mg/dL
|
0
|
|
|
> 40 mg/dL
|
1
|
|
serum creatinine
|
<= 1.2 mg/dL
|
0
|
|
|
> 1.2 mg/dL
|
2
|
|
INR
|
<= 1.5
|
0
|
|
|
> 1.5
|
2
|
|
platelet count
|
>= 150,000 per µL
|
0
|
|
|
< 150,000 per µL
|
1
|
|
serum SGOT
|
<= 40 U/L
|
0
|
|
|
> 40 U/L
|
1
|
|
serum sodium
|
<= 145 mmol/L
|
0
|
|
|
> 145 mmol/L
|
1
|
|
ventilator requirement
|
no
|
0
|
|
|
yes
|
3
|
|
WBC count
|
< 4,500 per µL
|
1
|
|
|
4,500 to 15,000
|
0
|
|
|
15,001 to 25,000
|
1
|
|
|
> 25,000 per µL
|
2
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 15
• The higher the score the greater the mortality.
|
Total Score
|
Mortality Rate
|
|
0
|
1.7%
|
|
1
|
3.1%
|
|
2
|
5.7%
|
|
3
|
9.1%
|
|
4
|
14.4%
|
|
5
|
20.4%
|
|
6
|
25.6%
|
|
7
|
34.2%
|
|
8
|
40.6%
|
|
9
|
45.9%
|
|
10
|
55.3%
|
|
11
|
58.3%
|
|
12
|
64.5%
|
|
13
|
51.6% (trend 80%)
|
|
14
|
100%
|
|
15
|
100%
|
Performance:
• The area under the ROC curve is 0.80.
