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Review
Risk stratification tools in emergency general surgery
  1. Joaquim Michael Havens1,2,
  2. Alexandra B Columbus2,
  3. Anupamaa J Seshadri1,
  4. Carlos V R Brown3,
  5. Gail T Tominaga4,
  6. Nathan T Mowery5,
  7. Marie Crandall6
  1. 1 Division of Trauma, Burns and Surgical Critical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  2. 2 Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  3. 3 Division of Acute Care Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
  4. 4 Department of Surgery, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
  5. 5 Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
  6. 6 Department of Surgery, University of Florida College of Medicine, Jacksonville, Florida, USA
  1. Correspondence to Dr Joaquim Michael Havens, Division of Trauma, Burns and Surgical Critical Care, Brigham and Women’s Hospital, Boston, MA 02115, USA; jhavens{at}bwh.harvard.edu

Abstract

The use of risk stratification tools (RST) aids in clinical triage, decision making and quality assessment in a wide variety of medical fields. Although emergency general surgery (EGS) is characterized by a comorbid, physiologically acute patient population with disparately high rates of perioperative morbidity and mortality, few RST have been explicitly examined in this setting. We examined the available RST with the intent of identifying a tool that comprehensively reflects an EGS patients perioperative risk for death or complication. The ideal tool would combine individualized assessment with relative ease of use. Trauma Scoring Systems, Critical Care Scoring Systems, Surgical Scoring Systems and Track and Trigger Models are reviewed here, with the conclusion that Emergency Surgery Acuity Score and the American College of Surgeons National Surgical Quality Improvement Programme Universal Surgical Risk Calculator are the most applicable and appropriate for EGS.

  • emergency general surgery
  • risk adjustment

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/tsaco-2017-000160

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    Footnotes

    • Contributors Study design: JMH, MC. Literature search: JMH, ABC, CVRB, GTT, NTM, MC. Data analysis and interpretation: JMH, ABC, CVRB, GTT, NTM, MC. Writing and critical revisions: JMH, ABC, AJS, CVRB, GTT, NTM, MC.

    • Funding No funding was received for this work.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.