From the Clinica Chirurgica 3, Department of Surgical, Oncological and Gastroenterological Sciences, Università di Padova, Padova, Italy.
J Trauma Acute Care Surg. 2022 Jan 1;92(1):108-116. doi: 10.1097/TA.0000000000003417.
Esophageal perforation (EP) is characterized by high morbidity and mortality. The Pittsburgh Severity Score (PSS) is a scoring system based on clinical factors at the time of EP presentation, intended to guide treatment. The aim of the study is to verify PSS usefulness in stratifying EP severity and in guiding clinical decisions.
All patients referred to our unit for EP between January 2005 and January 2020 were enrolled. Patients were stratified according to their PSS into three groups (PSS ≤ 2, 3-5, and >5): the postoperative outcomes were compared. The predictive value of the PSS was evaluated by simple linear and logistic regression for the following outcomes: need for surgery, complications, in-hospital mortality, intensive care unit (ICU) and hospital stay, time to refeeding, and need for reintervention.
Seventy-three patients were referred for EP (male/female, 46/27). Perforations were more frequently iatrogenic (41.1%) or spontaneous (38.3%). The median PSS was 4 (interquartile range, 2-6). Surgery was required in 60.3% of cases. Pittsburgh Severity Score was associated with ICU admission, hospital stay, need for surgery and reintervention, postperforation complications and mortality. After regression analysis, PSS was significantly predictive of postperforation complications (p < 0.01), in-hospital mortality (p = 0.01), ICU admission (p < 0.01), need for surgical treatment (p < 0.01), and need for reintervention (p = 0.02).
Pittsburgh Severity Score is useful in stratifying patients in risk groups with different morbidity and mortality. It is also useful in guiding the therapeutic conduct, selecting patients for nonoperative management. Prospective studies are needed to confirm the role of the PSS in the treatment of esophageal perforation.
Management, Therapeutic/Care; level IV.
食管穿孔（EP）的发病率和死亡率均较高。匹兹堡严重程度评分（PSS）是一种基于 EP 发生时临床因素的评分系统，旨在指导治疗。本研究旨在验证 PSS 在分层 EP 严重程度和指导临床决策方面的作用。
纳入 2005 年 1 月至 2020 年 1 月期间因 EP 就诊于我院的所有患者。根据 PSS 将患者分为三组（PSS≤2、3-5 和>5）：比较术后结果。通过简单线性和逻辑回归评估 PSS 对以下结果的预测价值：手术需求、并发症、院内死亡率、重症监护病房（ICU）和住院时间、重新喂养时间和再次干预需求。
共纳入 73 例 EP 患者（男/女，46/27）。穿孔更常由医源性（41.1%）或自发性（38.3%）引起。PSS 中位数为 4（四分位距，2-6）。60.3%的病例需要手术。PSS 与 ICU 入住、住院时间、手术和再次干预需求、穿孔后并发症和死亡率相关。回归分析后，PSS 对穿孔后并发症（p<0.01）、院内死亡率（p=0.01）、ICU 入住（p<0.01）、手术治疗需求（p<0.01）和再次干预需求（p=0.02）具有显著预测价值。
PSS 可用于对具有不同发病率和死亡率的风险组患者进行分层。它还可用于指导治疗方案，选择非手术治疗的患者。需要前瞻性研究来确认 PSS 在食管穿孔治疗中的作用。
治疗，治疗/护理；IV 级。
