DIAGNOSTIC ACCURACY OF BOEY SCORE TO PREDICT 30 DAYS MORTALITY IN PERFORATED PEPTIC ULCER PATIENTS

S WASEEM; K YAQUB; W AKRAM; ZA MEMON; A AHSAN; UA TURAB; IA RAJPUT; NA KHAN

doi:10.54112/bcsrj.v2024i1.1064

Authors

S WASEEM Patel Hospital, Karachi, Pakistan
K YAQUB Zubaida Medical Center, Karachi, Pakistan
W AKRAM Saifee Hospital, Karachi, Pakistan
ZA MEMON Dow University of Health Sciences, Karachi, Pakistan
A AHSAN Dow University of Health Sciences, Karachi, Pakistan
UA TURAB Dow University of Health Sciences, Karachi, Pakistan
IA RAJPUT Dow University of Health Sciences, Karachi, Pakistan
NA KHAN Dow University of Health Sciences, Karachi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.1064

Keywords:

Boey Score; Mortality Prediction; Perforated Peptic Ulcer; Risk Stratification; Surgical Outcomes; Peritonitis; 30-Day Mortality

Abstract

Perforated peptic ulcers remain a life-threatening condition despite advancements in surgical and medical treatments. Accurate risk stratification of patients can improve outcomes by guiding clinical decision-making. The Boey scoring system is widely used for predicting mortality in patients with perforated peptic ulcers, yet its diagnostic accuracy warrants further evaluation. Objective: This study aimed to evaluate the diagnostic accuracy of the Boey score in predicting 30-day mortality among patients with perforated peptic ulcers. Methods: This cross-sectional study was conducted at the Department of Surgical Unit VI, Civil Hospital Karachi, over a six-month period from December 7, 2020, to June 7, 2021. A total of 149 patients diagnosed with perforated peptic ulcers were included using non-probability consecutive sampling. The Boey score was calculated for each patient based on preoperative shock, comorbid illness, and duration of perforation >24 hours. The primary outcome measure was 30-day mortality. Descriptive statistics were used to assess the frequency distribution of mortality, and the association between Boey score and mortality was analysed using appropriate statistical methods, with significance set at p < 0.05. Results: The study included 149 patients, with a minimum age of 21 and a maximum age of 50. Of the total, 32 patients (21.5%) experienced 30-day mortality. Among patients with a Boey score of 1, 2.68% had 30-day mortality, and 0.67% of patients with a Boey score of 2 died. Patients with a Boey score of 3 had the highest mortality rate, with 18.1% of this group experiencing 30-day mortality. In contrast, 81.9% of patients with a Boey score of 1 to 3 survived beyond 30 days. Conclusion: The Boey scoring system demonstrated vital predictive accuracy for 30-day mortality in patients with perforated peptic ulcers. This scoring tool effectively identifies high-risk patients, allowing for timely and appropriate management. Despite modern treatment advances, perforated peptic ulcer remains associated with significant mortality, particularly in high-risk patients, as identified by the Boey score.

Downloads

Download data is not yet available.

References

Møller M, Adamsen S, Thomsen R, Møller A. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation. Journal of British Surgery. 2011;98(6):802-10.

Noguiera C, Silva AS, Santos JN, Silva AG, Ferreira J, Matos E, et al. Perforated peptic ulcer: main factors of morbidity and mortality. World journal of surgery. 2003;27:782-7.

Hermansson M, von Holstein CS, Zilling T. Surgical approach and prognostic factors after peptic ulcer perforation. The European journal of surgery. 1999;165(6):566-72.

Testini M, Portincasa P, Piccinni G, Lissidini G, Pellegrini F, Greco L. Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer. World Journal of Gastroenterology. 2003;9(10):2338.

Mäkelä JT, Kiviniemi H, Ohtonen P, Laitinen SO. Factors that predict morbidity and mortality in patients with perforated peptic ulcers. The European journal of surgery. 2002;168(8-9):446-51.

Kujath P, Schwandner O, Bruch H-P. Morbidity and mortality of perforated peptic gastroduodenal ulcer following emergency surgery. Langenbeck's Archives of Surgery. 2002;387:298-302.

Sillakivi T, Lang A, Tein A, Peetsalu A. Evaluation of risk factors for mortality in surgically treated perforated peptic ulcer. Hepato-gastroenterology. 2000;47(36):1765-8.

Svanes C, Lie RT, Svanes K, Lie SA, Søreide O. Adverse effects of delayed treatment for perforated peptic ulcer. Annals of surgery. 1994;220(2):168.

Malfertheiner P, Chan FK, McColl KE. Peptic ulcer disease. The Lancet. 2009;374(9699):1449-61.

Lau JY, Barkun A, Fan D-m, Kuipers EJ, Yang Y-s, Chan FK. Challenges in the management of acute peptic ulcer bleeding. The Lancet. 2013;381(9882):2033-43.

Thorsen K, Søreide JA, Søreide K. What is the best predictor of mortality in perforated peptic ulcer disease? A population-based, multivariable regression analysis including three clinical scoring systems. Journal of Gastrointestinal Surgery. 2014;18:1261-8.

Lohsiriwat V, Prapasrivorakul S, Lohsiriwat D. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality. World journal of surgery. 2009;33:80-5.

Agarwal A, Jain S, Meena L, Jain SA, Agarwal L. Validation of Boey’s score in predicting morbidity and mortality in peptic perforation peritonitis in Northwestern India. Tropical Gastroenterology. 2016;36(4):256-60.

Gulzar JS, Paruthy SB, Arya SV. Improving outcome in perforated peptic ulcer emergency surgery by Boey scoring. International Surgery Journal. 2016;3(4):2120-8.

SD N. Boey Score in predicting outcome in perforated peptic ulcer from tertiary referral centre of Nepal. ARC J Surg. 2018;5(1):9-14.

Britto DD, Kashyap AR, Prakash S. FRAILTY OF BOEY SCORE IN PPU MORTALITY AND MORBIDITY PREDICTION-A PROSPECTIVE STUDY. Journal of Evolution of Medical and Dental Sciences. 2017;6(77):5482-6.

Pant P, Acharya N, Rajbhandary A. Use of Boey’s score in peptic perforation disease in the Nepalese population: a prospective observational study.

Jain U, Chauhan A, Gupta J, Gupta A. Evaluation of Boey scoring in predicting morbidity and mortality in peptic ulcer perforation peritonitis. Int J Surg Sci. 2021;5(3):41-3.