IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 17, Issue 5 Ver. 14(May. 2018), PP 41-45 www.iosrjournals.org DOI: 10.9790/0853-1705144145 www.iosrjournals.org 41 | Page Validation of the Use of Possum Score in Emergency Abdominal Surgery in Government Hospital Setting. Dr. Rajesh Prajapati 1, Dr. Manisha Singh 2 , Dr. Ankur Singhal 3 1 Associate Professor, Dept Of Surgery, Gajra Raja Medical College, Gwalior– 474001 2 Associate Professor, Dept Of Surgery, Gajra Raja Medical College, Gwalior– 474001 3 Senior Resident Dept Of Surgery, Gajra Raja Medical College, Gwalior– 474001 Corresponding author:Dr. Rajesh Prajapati Abstract Introduction: Acute abdomen may be a life-threateningcondition particularly when evaluation of the patient in emergency department with acute abdominal pain is obscured by its myriad presentation, delaying or preventing the correct diagnosis, with subsequent adverse patient outcomes requiring surgery. In such patients requiring surgery, a scoring system can be used to audit and evaluate efficiency in hospital care and prevent subsequent morbidity and mortality. The objective was to study spectrum of abdominal emergencies and validate POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity score) in government hospital setting in patients undergoing subsequent laparotomy and their prognosis. Materials and methods:Prospective study of 400 patients admitted in JA GROUP OF HOSPITAL, Gwalior and underwent laparotomy for abdominal emergencies from January 2016 to December 2017. Parameters for calculating POSSUM score were retrieved. Observed: expected (O: E) ratios for morbidity and mortality calculated using linear and exponential analysis. Results:Out of 400 patients, most no. of patients were between age group 31 – 40 (n = 41) and most were males (n = 160). Small bowel perforation (n=101) followed by gastro-duodenal perforation (n=81) were commonest. Post-operative complications were seen in 89 patients (44.5%) and 16 patients (8%) died post operatively. O: E ratio for morbidity and mortality using linear analysis were 0.69 and 0.37 respectively. Using exponential analysis. O: E ratio for morbidity and mortality for strata 60-100 were 0.82 and 1.06 respectively. Conclusion:POSSUM score is an accurate tool for predicting morbidity and mortality in perforation peritonitis, even though it is over predicting morbidity and mortality in lower risk group. --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 12-05-2018 Date of acceptance: 29-05-2018 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Certain patients present in the emergency with acute abdomen and require subsequent emergent treatmentwhich may involve surgery. 1 Despite advancements in surgical techniques, anti–microbial therapy and intensive care, management of these emergency procedures continues to be highly demanding, difficult and complex. 2. These Emergency procedures which require laparotomies are performed commonly throughout the world, but one in six patients die within a month. to reduce this consecutive mortality and morbidity, A lot of research has been carried out to assess the individual risk in predicting mortality and morbidity of the patient to demonstrate reliable association between presentations, co-morbidities and operative procedures out of which most frequently studied general tools were APACHE II, ASA-PS and P-POSSUM. Outcome of all surgical procedure performed mainly depends on the pre and post-operative clinical status of the patient including their inter-current illness, nature and extent of surgical intervention, and co- morbid conditions influencing the patient final outcome. Therefore, it is being felt since long to develop a system, which can predict outcome of the surgery performed. The ability to compare results of surgeries and their outcome has become increasingly important in recent years. Interest is focused on the development of scoring systems that standardize patient data to allow meaningful comparisons. 4 In 1991, Copeland GP et al. while working in Broad green hospital, Liverpool, UK, devised, Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM). The POSSUM system is a two-part scoring system that includes a physiological assessment and a measure of operative severity. It was found to be quick, easy to use, and could be applied for both elective and emergency work and accurately predict outcome. The physiological part of the score includes 12 variables, each divided into 4 grades with an exponentially increasing score (1, 2, 4, and 8). The physiological variables are those apparent at the time of surgery and include clinical symptoms and signs, results of simple biochemical and haematological investigations, and electrocardiographic changes.