Possum scoring system for predicting prognosis in patients of perforation peritonitis

Background:  Peritonitis due to perforation of gastrointestinal viscous is one of the most common surgical emergency in India. A need for such a scoring system was felt which could better define the prognosis of such patients with respect to mortality and morbidity for better patient management. Emphasizing that Perforation peritonitis is one of the commonest surgical emergencies in lower strata of the population that is encountered in a rural hospital, this study was undertaken to evaluate POSSUM (physiological and operative severity score for the enumeration of mortality and morbidity) in defining the prognosis of patients and to deliver efficient management. Methods: 157 patients of perforation peritonitis who were admitted in Surgery wards over a period of 3 years were studied in this cross- sectional study. POSSUM Score was calculated for each patient by using the POSSUM Calculator. ROC analysis was done to find the cut off point for POSSUM. Results:  The cut- off was 35 which gave the Sensitivity and Specificity to be 100% and 72.29% respectively. The mortality rate was 5.7%. Conclusions:  This was one of the first studies in a rural setup in India where POSSUM scoring system was specifically applied for patients of Perforation Peritonitis. An increasing POSSUM score was associated with higher morbidity and mortality, hence it was concluded that POSSUM is an effective scoring system for predicting outcome in patients of perforation peritonitis.