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Ressources et utilitaires

Scoring systems for ICU and surgical patients:

POSSUM (Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity) 

Glasgow (Help)
Pulse (beats/min)
Cardiac signs
Hb (g/dL)
Potassium (mEql/L)
Sodium (mEql/L)
Systolic Blood Pressure
Physiologic Score

Operative Severity (help)
Multiple procedures
Total Blood Loss
Peritoneal soiling
Mode of surgery
Operative Score

Predicted Morbidity Rate
(Definitions are following)
  Predicted Mortality Rate
x = (0.16* physiologic score)+(0.19*operative score)- 5.91
Predicted Morbidity Rate = 1/(1+ e(-x))
y = (0.13* physiologic score)+(0.16*operative score)-7.04
Predicted Mortality Rate = 1/(1+ e(-y))

Ref : Copeland GP et al. POSSUM : a scoring system for surgical audit. Br J Surg. 1991;78: 356-60. 

Morbidity : definitions 

Wound haemorrhage : local haematoma requiring evacuation.
Deep haemorrhage: postoperative bleeding requiring re-exploration.
Chest infection: production of purulent sputum with positive bacteriological cultures, with or without chest radiography changes or pyrexia, or consolidation seen on chest radiograph.
Wound infection : wound cellulitis or the discharge of purulent exsudate.
Urinary infection: the presence of > 10 5 bacteria / ml with the presence of withe cells in the urine, in previously clear urine.
Deep infection: the presence of an intra-abdominal collection confirmed clinically or radiologically.
Septicaemia :
positive blood culture.
Pyrexia of unknown origin : any temperature above 37° C for more than 24 h occuring after the original pyrexia following surgery (if present) had settled , for which no obvious cause could be found.
Wound dehiscence : superficial or deep wound breakdown.
Deep venous thrombosis and pulmonary embolus : when suspected, confirmed radiologically by venography or ventilation/ perfusion scanning or diagnosed at post mortem.
Cardiac failure : symptoms or signs of left ventricular or congestive cardiac failure ( alteration from preoperative measures)
Impaired renal function : arbitrarily defined as an increase in blood urea of > 5 mmol / l from preoperative levels .
Hypotension : a fall in systolic blood pressure below 90 mmHg for more than 2 H as determined by sphygmomanometry or arterial pressure transducer measurement
Respiratory failure : respiratory difficulty requiring emergency ventilation.
Anastomotic leak : discharge of bowel content via the drain, wound or abnormal orifice.

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Moderate surgery : cholecystectomy, appendicectomy, mastectomy, transurethral resection of prostate
Major surgery : any laparotomy , bowel resection, cholecystectomy with choledochotomy, peripheral vascular procedure or major amputation
Major surgery + : any aortic procedure, abdominoperineal resection, pancreatic or liver resection, oesophagogastrectomy.

Eyes Open Verbal Motor
To speech
To pain
Converses / Oriented
Converses / Disoriented
Localizes pain
Withdraws (flexion)
Decorticate (flexion) rigidity
Decerebrate (extension) rigidity


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