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Proposed definitions for diagnosis, severity scoring, stratification, and outcome for trials on intraabdominal infection

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Abstract

Analysis of the experience with scientific studies on patients with secondary intraabdominal infection has revealed that problems of interpretation and comparability between studies exist as they relate to variable diagnostic criteria, unmeasured severity of disease, and unclear outcome measures. A consistent system of definitions has been developed to address these deficiencies. Intraabdominal infection is defined as clinical peritonitis requiring both operative and microbiological confirmation for proof of infection. The APACHE II system is proposed for grading the severity of the infection and for stratification of patient risk of mortality. Mortality and time until death, on one hand, and recovery and time until recovery, on the other, are proposed as the main outcome measures, both being independently and positively defined. It is anticipated that this system of minimum rules will produce studies that can be compared, hence, accelerating knowledge and understanding about intraabdominal infection and its best treatment.

Résumé

L'analyse des différentes études scientifiques sur les infections intra-abdominales a montré que les problèmes d'interprétation et de comparabilité relèvent de critiques diagnostiques variables, et de l'absence d'évaluation de la sévérité de la maladie, et de son évolution. Un système de définitions a été développé pour pallier ces déficiences. L'infection intra-abdominale se définit comme péritonite clinique exigeant la confirmation opératoire et microbiologique de l'infection. Le score APACHE II est proposé pour classer l'infection selon sa sévérité et prévoir le risque de mortalité. Mortalité et délai avant la mort, guérison st délai avant la guérison sont proposés comme critères d'évolution. On espére que le fait d'adopter ces règles permettra de comparer les études et fera progresser notre compréhension de l'infection intra-abdominale et son traitement.

Resumen

El análisis de los resultados de investigaciones científicas en pacientes con infección intraabdominal secundaria ha revelado que los problemas de interpretación y comparabilidad entre los diversos estudios se relacionan con criterios diagnósticos variables, con gravedad no definida de la enfermedad, y con parámetras indeterminados de desenlace. Se ha establecido un Sistema consistente de definiciones con el objeto de eliminar tales deficiencias. La infección intraabdominal es definida como una peritonitis clfnica que requiere confirmación, tanto operatoria como microbiológica como prueba de la infección. Se propone el sistema APACHE II para determinar el grado de gravedad de la infección y para la estratificación del riesgo de mortalidad. La mortalidad y el período hasta la muerte del paciente por un lado, y la recuperación y el perfodo hasta la recuperación por otro, son propuestos como los parámetras principales de desenlace, ambos definidos en forma independiente y positiva. Se espera que este sistema de reglas mínimas habrá de producir estudios que sean comparables, lo cual acelere la adquisición de nuevos conocimientos y la mejor comprensión de la infección intraabdominal y de su tratamiento.

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Authors and Affiliations

  1. Department of Surgery, University Hospital, S-581 85, Linköping, Sweden

    Per -Olof Nyström M.D.

  2. Manchester, England, UK

    Richard Bax M.D.

  3. Seattle, Washington, USA

    E. Patchen Dellinger M.D.

  4. Varese, Italy

    Lorenzo Dominioni M.D.

  5. Washington, D.C., USA

    William A. Knaus M.D.

  6. Montreal, Quebec, Canada

    Jonathan L. Meakins M.D.

  7. Düsseldorf, Federal Republic of Germany

    Christian Ohmann Ph.D.

  8. Cincinnati, Ohio, USA

    Joseph S. Solomkin M.D.

  9. Frankfurt/Main, Federal Republic of Germany

    Hannes Wacha M.D.

  10. Milwaukee, Wisconsin, USA

    Dietmar H. Wittmann M.D., Ph.D.

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Nyström, P.O., Bax, R., Dellinger, E.P. et al. Proposed definitions for diagnosis, severity scoring, stratification, and outcome for trials on intraabdominal infection. World J. Surg. 14, 148–158 (1990). https://doi.org/10.1007/BF01664867

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