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

INTRODUCTION

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.

METHODS

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.

RESULTS

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, p=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, p=0.092).

CONCLUSIONS

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.

Exploring self-determined solutions to service and system challenges to promote social and emotional wellbeing in Aboriginal and Torres Strait Islander people: a qualitative study

Introduction

Many Aboriginal and Torres Strait Islander people living on Kaurna Country in northern Adelaide experience adverse health and social circumstances. The Taingiwilta Pirku Kawantila study sought to understand challenges facing Aboriginal and Torres Strait Islander communities and identify solutions for the health and social service system to promote social and emotional wellbeing.

Methods

This qualitative study applied Indigenous methodologies undertaken with Aboriginal and Torres Strait Islander governance and leadership. A respected local Aboriginal person engaged with Aboriginal and Torres Strait Islander community members and service providers through semi-structured interviews and yarning circles that explored community needs and challenges, service gaps, access barriers, success stories, proposed strategies to address service and system challenges, and principles and values for service design. A content analysis identified the breadth of challenges in addition to describing key targets to empower and connect communities and optimize health and social services to strengthen individual and collective social and emotional wellbeing.

Results

Eighty-three participants contributed to interviews and yarning circles including 17 Aboriginal community members, 38 Aboriginal and Torres Strait Islander service providers, and 28 non-Indigenous service providers. They expressed the need for codesigned, strengths-based, accessible and flexible services delivered by Aboriginal and Torres Strait Islander workers with lived experience employed in organisations with Aboriginal and Torres Strait Islander leadership and governance. Community hubs and cultural events in addition to one-stop-shop service centres and pre-crisis mental health, drug and alcohol and homelessness services were among many strategies identified.

Conclusion

Holistic approaches to the promotion of social and emotional wellbeing are critical. Aboriginal and Torres Strait Islander people are calling for places in the community to connect and practice culture. They seek culturally safe systems that enable equitable access to and navigation of health and social services. Aboriginal and Torres Strait Islander workforce leading engagement with clients is seen to safeguard against judgement and discrimination, rebuild community trust in the service system and promote streamlined access to crucial services.

Visual color and doneness indicators and the incidence of premature brown color in beef patties cooked to four end point temperatures

An interlaboratory study was undertaken to assess the frequency that cooked color of ground beef patties appeared brown at internal temperatures of 52.7 degrees C (135 degrees F), 65.6 degrees C (150 degrees F), 71.1 degrees C (160 degrees F), and 79.4 degrees C (175 degrees F). In general, as internal cooked temperature of the patties increased, the following results were observed in the patties: (i) more brown meat color, (ii) less pink or red juice color, and (iii) more cooked texture. However, brown meat color occurred prematurely at the two lower internal temperatures (57.2 degrees C/135 degrees F and 65.6 degrees C/150 degrees F) that are insufficient to eliminate foodborne pathogens without holding times. The common consumer practice of freezing bulk ground beef, followed by overnight thawing in a refrigerator, led to substantial premature brown color in patties cooked from this product. In addition, at 71.1 degrees C (160 degrees F), recognized to be the lowest temperature for cooking ground beef safely in the home, meat color, juice color, and texture appearance were not fully apparent as doneness indicators. In fact, at no temperature studied did 100% of the patties appear done when evaluated by the criteria of no red or pink in the meat, no red or pink in the juices, or by texture appearance. Patties in this study were evaluated under a set protocol for forming the products, cooking, and viewing under the same lighting conditions. Other preparation conditions are possible and may produce different results. Thus, temperature to which patties have been cooked cannot be judged by color and appearance. This study provided the evidence to support the message to consumers regarding cooking of beef patties of "use an accurate food thermometer and cook beef patties to 160 degrees F (71.1 degrees C)" in place of messages based on consumer judgment of cooked color.