Publication: Can the emergency surgery score (ESS) be used as a triage tool predicting the postoperative need for an ICU admission?
Issued Date
2019-01-01
Resource Type
ISSN
18791883
00029610
00029610
Other identifier(s)
2-s2.0-85058575480
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Mahidol University
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SCOPUS
Bibliographic Citation
American Journal of Surgery. Vol.217, No.1 (2019), 24-28
Suggested Citation
Napaporn Kongkaewpaisan, Jae Moo Lee, Ahmed I. Eid, Manasnun Kongwibulwut, Kelsey Han, David King, Noelle Saillant, April E. Mendoza, George Velmahos, Haytham M.A. Kaafarani Can the emergency surgery score (ESS) be used as a triage tool predicting the postoperative need for an ICU admission?. American Journal of Surgery. Vol.217, No.1 (2019), 24-28. doi:10.1016/j.amjsurg.2018.08.002 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/52328
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Title
Can the emergency surgery score (ESS) be used as a triage tool predicting the postoperative need for an ICU admission?
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Abstract
© 2018 Elsevier Inc. Background: The emergency surgery score (ESS) is a preoperative risk calculator recently validated as a mortality predictor in emergency surgery (ES) patients. We sought to evaluate the utility of ESS as an ICU admission triage tool. Methods: A four-step methodology was designed. First, the 2007–2015 ACS-NSQIP database was examined to identify all ES patients using the “emergent” variable and CPT codes for “digestive system”. Second, we created a composite variable called ICUneed, defined as death or the development of one or more postoperative complication warranting critical care (e.g. unplanned intubation, ventilator dependent ≥48 h, cardiac arrest, septic shock and coma ≥24 h). Third, for each patient, ESS was calculated. Fourth, the correlation between ESS and ICUneed was assessed by calculating the model c-statistics (AUROC). Results: Out of a total of 4,456,809 patients, 65,989 patients were included. The mean population age was 56 years; 51% were female, and 71% were white. The overall 30-day postoperative mortality and morbidity were 8.2% and 31.7%, respectively. ESS gradually and accurately predicted ICUneed, with 1%, 40% and 98% of patients with ESS of 2, 9 and 16 requiring critical care, respectively. Only 6.2% of patients with ESS ≤7 had an ICUneed, while 97.2% of patients with ESS ≥15 had an ICUneed. The c-statistic of the predictive model was 0.90. Conclusions: ESS accurately predicts the need for postoperative critical care and ICU admission. In resource-limited settings, ESS may prove useful as an ICU triage tool ensuring a prompt rescue of the clinically deteriorating patient without unnecessary and burdensome ICU admissions.