Validation of the emergency surgery score (ESS) in a UK patient population and comparison with NELA scoring: a retrospective multicentre cohort study

Accurate risk scoring in emergency general surgery (EGS) is vital for consent and resource allocation. The emergency surgery score (ESS) has been validated as a reliable preoperative predictor of postoperative outcomes in EGS but has been studied only in the US population. Our primary aim was to per...

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Bibliographic Details
Published in:	Annals of the Royal College of Surgeons of England Vol. 106; no. 5; pp. 439 - 445
Main Authors:	Clinch, D, Dorken-Gallastegi, A, Argandykov, D, Gebran, A, Proano Zamudio, J A, Wong, C S, Clinch, N, Haddow, L, Simpson, K, Imbert, E, Skipworth, Rje, Moug, S J, Kaafarani, Hma, Damaskos, D
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 01-05-2024 Royal College of Surgeons
Subjects:	Audits Cohort analysis Critical care Emergency Care Laboratories Laparoscopy Laparotomy Missing data Mortality Patients Quality improvement Risk assessment Surgery Variables United Kingdom > UK United States > US Scotland NELA Risk prediction ESS Emergency surgery score
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Summary:	Accurate risk scoring in emergency general surgery (EGS) is vital for consent and resource allocation. The emergency surgery score (ESS) has been validated as a reliable preoperative predictor of postoperative outcomes in EGS but has been studied only in the US population. Our primary aim was to perform an external validation study of the ESS in a UK population. Our secondary aim was to compare the accuracy of ESS and National Emergency Laparotomy Audit (NELA) scores. We conducted an observational cohort study of adult patients undergoing emergency laparotomy over three years in two UK centres. ESS was calculated retrospectively. NELA scores and all other variables were obtained from the prospectively collected Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) database. The primary and secondary outcomes were 30-day mortality and postoperative intensive care unit (ICU) admission, respectively. A total of 609 patients were included. Median age was 65 years, 52.7% were female, the overall mortality was 9.9% and 23.8% were admitted to ICU. Both ESS and NELA were equally accurate in predicting 30-day mortality (c-statistic=0.78 (95% confidence interval (CI), 0.71-0.85) for ESS and c-statistic=0.83 (95% CI, 0.77-0.88) for NELA, =0.196) and predicting postoperative ICU admission (c-statistic=0.76 (95% CI, 0.71-0.81) for ESS and 0.80 (95% CI, 0.76-0.85) for NELA, =0.092). In the UK population, ESS and NELA both predict 30-day mortality and ICU admission with no statistically significant difference but with higher c-statistics for NELA score. Both scores have certain advantages, with ESS being validated for a wider range of outcomes.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	0035-8843 1478-7083 1478-7083
DOI:	10.1308/rcsann.2023.0105