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Stratification of Etiology and Risk for Future Therapeutic Trials

Jonathan L. Meakins, MD; Joseph S. Solomkin, MD; Maria D. Allo, MD; E. Patchen Dellinger, MD; Richard J. Howard, MD; Richard L. Simmons, MD

Arch Surg. 1984;119(12):1372-1378.

Abstract
• Serious studies of ultra-abdominal infections have yielded a mortality that ranges from 3.5% (a composite of antibiotic studies evaluating 1,275 patients) to more than 60% in studies of multiple-organ failure. In reviewing these studies, it is apparent that under the umbrella of "serious intra-abdominal infection," different diseases, processes, and patients are being studied. We define a binomial classification incorporating both an anatomic and a functional approach to intra-abdominal infection. There are ten etiologic classifications of intra-abdominal infections combined with an acute physiologic score (APS), measuring severity of illness, in three gradations. In the patient with undifferentiated intra-abdominal sepsis, the patient will be in class I, II, III or IV, with a score, A, B, or C, added. Each of the groups V-X, defining a specific infectious category, can also use the APS, which has been verified in patients in intensive care and in those with intra-abdominal infection. It is anticipated that using this approach will provide a technique to evaluate patient groups uniformly in which drug or technical approaches to the management of intra-abdominal infections are being studied. The patients being studied will be more clearly defined, and studies will be comparable from one center to another.

(Arch Surg 1984;119:1372-1378)

Author Affiliations
From the Departments of Surgery, McGill University, Montreal (Dr Meakins), University of Cincinnati (Dr Solomkin), University of Colorado, Denver (Dr Allo), University of Washington, Seattle (Dr Dellinger), University of Florida, Gainesville (Dr Howard), and University of Minnesota, Minneapolis (Dr Simmons).

Footnotes
Accepted for publication Nov 28, 1983.

Reprint requests to Department of Surgery, Royal Victoria Hospital, 687 Pine Ave W, Montreal, Quebec, Canada H3A 1A1 (Dr Meakins).

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