PREDICTION OF OUTCOME USING THE MANNHEIM PERITONITIS INDEX IN CASES OF PERITONITIS
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2015, Vol 2, Issue 35
Abstract
Peritonitis still presents an extremely common & dreaded problem in emergency surgery. Despite aggressive surgical techniques, the prognosis of peritonitis and intra-abdominal sepsis is very poor, especially when multiple organ failure develops. Therefore early objective & reliable classification of the severity of peritonitis and intra-abdominal sepsis is needed not only to predict prognosis & to select patients for these aggressive surgical techniques but also to evaluate & compare the results of different treatment regimens. So, in this prospective study of 60 cases of peritonitis, the reliability of the Mannheim peritonitis index is assessed & its predictive power evaluated. MATERIALS & METHODS: This prospective study was carried out in the department of surgery, GMCH, Udaipur from June 2014 to June 2015 after taking the permission from institutional ethics committee. Patients from both sexes of various age groups having peritonitis of varied aetiology & who had undergone laparotomy were taken. A detailed history, thorough clinical examination & necessary investigations were performed in each case according to planned proforma. After resuscitation laparotomy was done & operative findings were noted carefully and a proper note on the progress of each patient was maintained and any complications encountered were noted. So, early classification of patients presenting with peritonitis by means of objective scoring system was done to select patients for aggressive surgery & overall morbidity & mortality were analyzed. RESULTS: Total 60 patients of peritonitis were examined and common causes were peptic (61.6%), typhoid (21.6%) and appendicular (8.3 %). Most common age group was found to be 21 to 50 years and male to female ratio was 4:1. Peritonitis was more common in patients involved in hard work and chronic Bedi smokers (61.6%). About 46% of patients who presented for treatment within 48 hours of onset of illness mortality was 0% compared to 25% in those who presented after 8 hours. Overall mortality rate was 13.3%. It was highest in the 2nd decade (25%) followed by the 5th, 6th, 7th decade (16.6% each) of life. Mortality steadily increased with increased in Mannheim peritonitis index score. For patients with a score less than 21 the mortality rate was 0%, for score 21-29 it was 14.2 % and for score greater than 29 the mortality rate was found to be 50%. Patients with a score less than 26 the mean mortality rate was 2.3% and for score greater than 26, it is 38.8%. For a threshold index score of 26, the sensitivity was 87.5% and specificity was 78.8% in predicting death. CONCLUSION: This study reaffirms the value of the Mannheim Peritonitis index in identifying high risk patients with peritonitis.
Authors and Affiliations
Sanjeev Agarwal, Lalit Shrimali, Ritu Mehta, Joshi C. P
Keywords
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- EP ID EP231886
- DOI 10.18410/jebmh/2015/750
- Views 85
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