Comparative analysis of APACHE-Ⅱ and P-POSSUM scoring systems in predicting postoperative mortality in patients undergoing emergency laparotomy

BACKGROUND Laparotomy remains one of the commonest emergency surgical procedures.Early prognostic evaluation would aid in selecting the high-risk patients for an aggressive treatment. Awareness about risks could potentially contribute to the quality of perioperative care and optimum utilization of resources. Portsmouth modification of Physiological and operative severity for the enumeration of mortality and morbidity(P-POSSUM) and the acute physiology and chronic health evaluation Ⅱ(APACHE-Ⅱ) have been the most widely used scoring systems for emergency laparotomies. It is always better to have a single scoring system to predict outcomes and audit healthcare organizations.AIM To compare the ability of APACHE-Ⅱ and P-POSSUM to predict postoperative morbidity and mortality in patients undergoing emergency laparotomy.METHODS All patients undergoing emergency laparotomy at the Tata Main Hospital,Jamshedpur between December 2013 and November 2014 were included in the study. In this observational study, P-POSSUM and APACHE-Ⅱ scoring were done, and the outcome analysis evaluated with mortality being the primary outcome.RESULTS For P-POSSUM, at a cut off value of 63 to predict mortality using receiver operating characteristics curve analysis, the area under the curve was 0.989; and for APACHE-Ⅱ, at the cut off value of 24, the area under the curve was 0.965.CONCLUSION Because the ability of APACHE-Ⅱ to predict mortality was similar to P-POSSUM and APACHE-Ⅱ does not need scoring for intra-operative findings and histopathology reports, APACHE-Ⅱ can be used pre-operatively to assess the risk in patients undergoing emergency laparotomy. However, for audit purposes,either of the two scoring systems can be used.

Impact of prior chemotherapy with two different fluoropyrimidines on the efficacy of capecitabine plus irinotecan or FOLFIRI with or without bevacizumab in metastatic colorectal cancer:a post hoc analysis of the AXEPT study

Dear Editor,Recently,the phase III Asian XELIRI(capecitabine plus irinotecan)ProjecT(AXEPT)study demonstrated the non-inferiority of modified capecitabine plus irinotecan(mXELIRI)±bevacizumab(Bev)to fluorouracil plus leucovorin with irinotecan(FOLFIRI)±Bev in terms of overall survival(OS)as a second-line treatment for patients with metastatic colorectal cancer[1,2].In the past decade,oral prodrugs of fluorouracil-containing regimens have shown similar efficacies to intravenous fluorouracilcontaining regimens.

Impact of measuring distance and exposure to cold outdoor environment on the temperature measurement using a non-contact infrared thermometer

To the Editor: Fever detection is critical for the screening and control of highly contagious febrile diseases. Axilla or rectal temperatures, although considered to be the gold standard for fever detection in clinical practice,[1] are impractical for mass screening. Rapid, cost-effective, and non-contact temperature measurement tools with high sensitivity and accuracy are needed. Non-contact infrared thermometer (NCIT) is one of the most commonly used tools for screening of corona virus disease 2019 in public settings in China, as fever is a typical and early manifestation. The distance between the sensor of NCIT and the skin surface might have a significant impact on the readings.[2] In addition, the fact of outdoor temperature being significantly lower than room temperature might lead to lower readings and therefore false-negative results. Previously, it was shown in a pediatric population that misleading temperature readings could happen if measurements were taken before the skin had adjusted to indoor temperature.[3] In this study, we aimed to assess the impact of distance of thermometer placement and exposure to cold outdoor environment on temperature measurement using a NCIT.