Derivation and Validation of a Novel Physiological Emergency Surgery Acuity Score
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To the Editor
The recent article by Sangji et al.  derivating and validating a novel physiological emergency surgery acuity score (PESAS) was of great interest. They show that the PESAS can assess the acuity of disease at presentation in emergency surgery patients and is strongly associated with postoperative mortality. The main strengths of this study are the use of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database including a relatively large sample of emergency surgery patients. Furthermore, the authors had applied properly statistical methods to derivate the PESAS. Given that accurate prediction of postoperative mortality is important for emergency surgery quality improvement, their findings have the potential implications. However, we noted the several aspects of this study that were not well addressed.
First, in designing the PESAS, it was unclear why Sangji et al. only included the preoperative variables related to health...
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