An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting.

BACKGROUND: POSSUM and P-POSSUM are used in the assessment of outcomes in surgical patients. Neither scoring systems' accuracy has been established where a level 1 critical care facility (level 1 care ward) is available for perioperative care. We compared POSSUM and P-POSSUM predicted with observed mortality on a level 1 care ward. METHODS: A prospective, observational study was performed between May 2000 and June 2008. POSSUM and P-POSSUM scores were calculated for all postoperative patients who were admitted to the level 1 care ward. Data for post-operative mortality were obtained from hospital records for 2552 episodes of patient care. Observed vs expected mortality was compared using receiver operating characteristic (ROC) curves and the goodness of fit assessed using the Hosmer-Lemeshow equation. RESULTS: ROC curves show good discriminative ability between survivors and non-survivors for POSSUM and P-POSSUM. Physiological score had far higher discrimination than operative score. Both models showed poor calibration and poor goodness of fit (Hosmer-Lemeshow). Observed to expected (O:E) mortality ratio for POSSUM and P-POSSUM indicated significantly fewer than expected deaths in all deciles of risk. CONCLUSIONS: Our data suggest a 30-60% reduction in O:E mortality. We suggest that the use of POSSUM models to predict mortality in patients admitted to level 1 care ward is inappropriate or that a recalibration of POSSUM is required to make it useful in a level 1 care ward setting.

Validating the Derbyshire Children's Hospital Pain Tool in children aged 6-12 years.

The Derbyshire Children's Hospital Paediatric Pain Chart (DPC) is the current pain assessment tool used at the Derbyshire Children's Hospital. It was originally devised as a simple pain tool for use in the post-operative clinical area. It is applicable across the spectrum of age groups that present for paediatric surgery. The DPC assesses pain by utilizing three parameters: facial expression, verbal (i.e. self-report) and body movement. This exploratory study was undertaken to determine its reliability and validity in children aged 6-12 years. The research nurse assessed 60 children aged 6-12 years undergoing minor and intermediate surgery and compared the DPC against the validated Oucher Scale. Assessments were performed preoperatively and for four hours post-operatively. Any analgesia administered post-operatively was recorded, and its effects noted. This study supports construct validity and inter-rater reliability of the DPC pain assessment tool for children aged 6-12 undergoing minor and intermediate surgery.

Validating the Derbyshire Children's Hospital Pain Tool: a pilot study.

BACKGROUND: The Derbyshire Children's Hospital Paediatric Pain Chart (DPC) is the current pain assessment tool used at the Derbyshire Children's Hospital. It was originally devised as a simple pain tool for use in the clinical area, and it is applicable for use in children of all ages within the postoperative setting. The pain assessment chart encompasses pain assessment by utilizing facial expression, body movement and verbal expression. An exploratory study was performed to define its reliability and validity. METHODS: The research nurse (V.P.) assessed 40 children aged 1-5 undergoing minor and intermediate surgery comparing the Toddler Preschooler Postoperative Pain Scale and the DPC. Assessments were performed preoperatively and for 4 h postoperatively. Any analgesia administered postoperatively was recorded. RESULTS: All the children scored 0 preoperatively with both pain scales, thus demonstrating known groups validity. There were 116 dual assessments by the research nurse using both pain scales. There was a strong correlation (r = 0.89) demonstrating convergent validity. There was a significant correlation between 182 joint assessments by the research nurse (V.P.) and the nursing staff using the DPC (Spearmans rank correlation, 0.81) and the Cronbach alpha coefficient ranged from 0.83 to 0.98. Construct validity was demonstrated by a fall in the mean pain scores from 1.8 to 0.1 following analgesia in 19 children. CONCLUSIONS: This exploratory study suggests the DPC holds construct, convergent and known groups validity and is a reliable pain assessment tool for children aged 1-5 years undergoing minor and intermediate surgery.