A decision rule to aid selection of patients with abdominal sepsis requiring a relaparotomy

BMC Surgery

Johannes B Reitsma¹  Marja A Boermeester²  Oddeke van Ruler²  Jordy JS Kiewiet² 

[1] Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands;Department of Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands

关键词: Decision rule;    Prediction model;    On-demand;    Relaparotomy;    Abdominal sepsis;    Secondary peritonitis;   

Others  :  866910
DOI  :  10.1186/1471-2482-13-28

 received in 2012-11-11, accepted in 2013-07-11,  发布年份 2013

【 摘 要 】

Background

Accurate and timely identification of patients in need of a relaparotomy is challenging since there are no readily available strongholds. The aim of this study is to develop a prediction model to aid the decision-making process in whom to perform a relaparotomy.

Methods

Data from a randomized trial comparing surgical strategies for relaparotomy were used. Variables were selected based on previous reports and common clinical sense and screened in a univariable regression analysis to identify those associated with the need for relaparotomy. Variables with the strongest association were considered for the prediction model which was constructed after backward elimination in a multivariable regression analysis. The discriminatory capacity of the model was expressed with the area under the curve (AUC). A cut-off analysis was performed to illustrate the consequences in clinical practice.

Results

One hundred and eighty-two patients were included; 46 were considered cases requiring a relaparotomy. A prediction model was build containing 6 variables. This final model had an AUC of 0.80 indicating good discriminatory capacity. However, acceptable sensitivity would require a low threshold for relaparotomy leading to an unacceptable rate of negative relaparotomies (63%). Therefore, the prediction model was incorporated in a decision rule were the interval until re-assessment and the use of Computed Tomography are related to the outcome of the model.

Conclusions

To construct a prediction model that will provide a definite answer whether or not to perform a relaparotomy seems a utopia. However, our prediction model can be used to stratify patients on their underlying risk and could guide further monitoring of patients with abdominal sepsis in order to identify patients with suspected ongoing peritonitis in a timely fashion.

【 授权许可】

   
2013 Kiewiet et al.; licensee BioMed Central Ltd.

【 图 表 】

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