An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting
Background POSSUM and P-POSSUM are used in the assessment of outcomes in surgical patients. Neither scoring systems’ accuracy has been established where a level 1 critical care facility (level 1 care ward) is available for perioperative care. We compared POSSUM and P-POSSUM predicted with observe...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Published: |
BioMed Central
2014
|
| Online Access: | https://eprints.nottingham.ac.uk/44549/ |
| _version_ | 1848796941886947328 |
|---|---|
| author | Scott, Sarah Lund, Jonathan N. Gold, Stuart Elliott, Richard Vater, Mair Chakrabarty, Mallicka P. Heinink, Thomas P. Williams, John P. |
| author_facet | Scott, Sarah Lund, Jonathan N. Gold, Stuart Elliott, Richard Vater, Mair Chakrabarty, Mallicka P. Heinink, Thomas P. Williams, John P. |
| author_sort | Scott, Sarah |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background
POSSUM and P-POSSUM are used in the assessment of outcomes in surgical patients. Neither scoring systems’ accuracy has been established where a level 1 critical care facility (level 1 care ward) is available for perioperative care. We compared POSSUM and P-POSSUM predicted with observed mortality on a level 1 care ward.
Methods
A prospective, observational study was performed between May 2000 and June 2008. POSSUM and P-POSSUM scores were calculated for all postoperative patients who were admitted to the level 1 care ward. Data for post-operative mortality were obtained from hospital records for 2552 episodes of patient care. Observed vs expected mortality was compared using receiver operating characteristic (ROC) curves and the goodness of fit assessed using the Hosmer-Lemeshow equation.
Results
ROC curves show good discriminative ability between survivors and non-survivors for POSSUM and P-POSSUM. Physiological score had far higher discrimination than operative score. Both models showed poor calibration and poor goodness of fit (Hosmer-Lemeshow). Observed to expected (O:E) mortality ratio for POSSUM and P-POSSUM indicated significantly fewer than expected deaths in all deciles of risk.
Conclusions
Our data suggest a 30-60% reduction in O:E mortality. We suggest that the use of POSSUM models to predict mortality in patients admitted to level 1 care ward is inappropriate or that a recalibration of POSSUM is required to make it useful in a level 1 care ward setting. |
| first_indexed | 2025-11-14T19:55:59Z |
| format | Article |
| id | nottingham-44549 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:55:59Z |
| publishDate | 2014 |
| publisher | BioMed Central |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-445492020-05-04T16:57:19Z https://eprints.nottingham.ac.uk/44549/ An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting Scott, Sarah Lund, Jonathan N. Gold, Stuart Elliott, Richard Vater, Mair Chakrabarty, Mallicka P. Heinink, Thomas P. Williams, John P. Background POSSUM and P-POSSUM are used in the assessment of outcomes in surgical patients. Neither scoring systems’ accuracy has been established where a level 1 critical care facility (level 1 care ward) is available for perioperative care. We compared POSSUM and P-POSSUM predicted with observed mortality on a level 1 care ward. Methods A prospective, observational study was performed between May 2000 and June 2008. POSSUM and P-POSSUM scores were calculated for all postoperative patients who were admitted to the level 1 care ward. Data for post-operative mortality were obtained from hospital records for 2552 episodes of patient care. Observed vs expected mortality was compared using receiver operating characteristic (ROC) curves and the goodness of fit assessed using the Hosmer-Lemeshow equation. Results ROC curves show good discriminative ability between survivors and non-survivors for POSSUM and P-POSSUM. Physiological score had far higher discrimination than operative score. Both models showed poor calibration and poor goodness of fit (Hosmer-Lemeshow). Observed to expected (O:E) mortality ratio for POSSUM and P-POSSUM indicated significantly fewer than expected deaths in all deciles of risk. Conclusions Our data suggest a 30-60% reduction in O:E mortality. We suggest that the use of POSSUM models to predict mortality in patients admitted to level 1 care ward is inappropriate or that a recalibration of POSSUM is required to make it useful in a level 1 care ward setting. BioMed Central 2014-11-18 Article PeerReviewed Scott, Sarah, Lund, Jonathan N., Gold, Stuart, Elliott, Richard, Vater, Mair, Chakrabarty, Mallicka P., Heinink, Thomas P. and Williams, John P. (2014) An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting. BMC Anesthesiology, 14 (1). 104/1-104/7. ISSN 1471-2253 https://bmcanesthesiol.biomedcentral.com/articles/10.1186/1471-2253-14-104 doi:10.1186/1471-2253-14-104 doi:10.1186/1471-2253-14-104 |
| spellingShingle | Scott, Sarah Lund, Jonathan N. Gold, Stuart Elliott, Richard Vater, Mair Chakrabarty, Mallicka P. Heinink, Thomas P. Williams, John P. An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting |
| title | An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting |
| title_full | An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting |
| title_fullStr | An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting |
| title_full_unstemmed | An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting |
| title_short | An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting |
| title_sort | evaluation of possum and p-possum scoring in predicting post-operative mortality in a level 1 critical care setting |
| url | https://eprints.nottingham.ac.uk/44549/ https://eprints.nottingham.ac.uk/44549/ https://eprints.nottingham.ac.uk/44549/ |