Maryam Razavi

maryam.razavi@cambio.se

Cambio CDS

To estimate morbidity and mortality in surgery patients based on clinical data.

Use at the time of surgery in patients undergoing emergency and elective general surgical procedures. The POSSUM score consists of two components, a physiological score (obtained from scoring 12 variables) and an operative score (obtained from scoring 6 variables). Individual variable scores range from 1 to 8. The physiological scores range from 12 to 88 whilst the operative scores range from 6 to 48. Variables and assigned points: Physiological Score Items: - Age: ≤ 60=1, 61-70=2, ≥ 71=4 - Cardiac: No failure=1, Diuretic, digoxin or angina/hypertension meds=2, Peripheral edema, warfarin, or borderline cardiomegaly on chest X-ray (CXR)=4, Raised jugular venous pressure, or cardiomegaly on CXR=8 - Respiratory: No dyspnea=1, Exertional dyspnea or mild COPD on CXR=2, Limiting dyspnea or moderate COPD on CXR=4, Dyspnea at rest or fibrosis/consolidation on CXR=8 - Systolic blood pressure (mmHg): 110-130=1, 131-170 or 100-109=2, ≥ 171 or 90-99=4, ≤ 89=8 - Pulse (beats/min): 50-80=1, 81-100 or 40-49=2, 101-120=4, ≥ 121 or ≤ 39=8 - Glasgow coma score: 15=1, 12-14=2, 9-11=4, ≤ 8=8 - Urea nitrogen (mmol/L): < 7.5=1, 7.6-10=2, 10.1-15=4, ≥ 15.1=8 -Sodium (mEq/L):> 136=1,131-135=2,126-130=4,≤ 125=8 - Potassium (mEq/L):3.5-5=1,3.2-3.4 or 5.1-5.3=2,2.9-3.1 or 5.4-5.9=4,≤ 2.8 or ≥ 6=8 - Haemoglobin (g/dL):13-16=1, 11.5-12.9 or 16.1-17=2, 10-11.4 or 17.1-18=4, ≤ 9.9 or ≥ 18.1=8 - WCC (x1012/L):4-10=1,10.1-20 or 3.1-3.9=2, ≥ 20.1 or ≤ 3=4 - Electrocardiogram: Normal=1, Atrial fibrillation (HR 60-90)=2, Any other change=8 Operative Score Items: Operative magnitude:Minor=1, Intermediate=2, Major=4, Major+=8 No. of operations within 30 days:1=1, 2=4, > 2=8 Blood loss per operation (mL): < 100=1,101-500=2,501-999=4,> 1000=8 Peritoneal contamination: No=1, Serious=2, Local pus=4, Free Bowel content, pus or blood=8 Presence of malignancy: No=1, Primary cancer only=2, Node metastases=4, Distant metastases=8 Timing of operation: Elective=1, Emergency resuscitation possible, operation <24h=4, Emergency immediate operation <2h=8 Formula: Physiological Score= Addition of selected points. Operative Score= Addition of selected points.

Not to be used for trauma patients or at the time of admission.

1. Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg. 1991; 78355- 360. 2. Copeland GP. The POSSUM System of Surgical Audit. Arch Surg. 2002; 137(1):15-19.

OBSERVATION.possum.v0