Last modified: 2022-08-14
Abstract
Background: Esophageal perforation (EP) is a rare emergency, characterized by high morbidity and mortality. Management and outcome are dependent upon the time of presentation, clinical condition, underlying disease condition, timely intervention etc. Pittsburgh Severity Score(PSS) was proposed to predict outcome of patients of EP. The aim of this study is to assess usefulness of PSS in deciding the management and predicting outcome of the patients.
Methods: All patients referred between 1995 and 2022 were enrolled. Patients were stratified according to their PSS into 3 groups [ ≤ 2, 3–5, and > 5]. The demographic profile, clinical parameters, interventions, and outcomes were compared. Groups were compared using univariate and multivariate analysis using SPSS software and p-value of <0.05 was considered significant.
Results: Thirty patients with EP were enrolled. Average age was 46.5 years and majority were males (24, 80%). Most of them presented >24 hours (n=26, 86.7%) of EP. Trauma was the most common etiology (9, 30%) and most frequent site was the thoracic esophagus (21, 70%). Mean PSS was 7. Eight patients (26.7%) were managed non-operatively and rest underwent surgery. Four (13.3%) patients had mortality due to septic shock. Median length of hospital stay was 13.5 days. Comparing different groups, PSS>5 had higher mortality and significantly higher pulse rate, respiratory compromise; however, it didn’t have any impact on management decision making.
Conclusion: Higher PSS is an indicator of poor outcome; however doesn’t predict treatment plan. Hence, in patients of EP ,management has to be individualized, independent of PSS.