Comparison of Predictive Validity of PULP and Boey’s score in Predicting the Risk of Peptic Ulcer Perforations: A Prospective Observational Study

Abstract

ackground: Peptic ulcer perforation is a life-threatening surgical emergency with significant morbidity and mortality.

Objectives: To evaluate the effectiveness of the PULP and Boey scoring systems in assessing the severity of peptic ulcer perforation; and to analyze the correlation between these scoring systems and the duration of ICU and hospital stay, as well as to assess their role in predicting postoperative complications.

Methods: This was a hospital based prospective observational study conducted in the Department of General Surgery, JSS Medical College, Karnataka, India for a duration of 18 months among patients more than 18 years of age with hollow viscus perforation.

Results: This study included 42 participants with a mean age of 64.6 years (SD = 9.1). A majority (64.3%) were aged 60 years and above, and 73.8% were male. Mortality was significantly higher in older patients (p = 0.032), with non-survivors having a mean age of 71.8 years (SD = 7.5) compared to 62.1 years (SD = 8.3) in survivors (p = 0.001). Delayed presentation beyond 24 hours was significantly associated with mortality (81.8% vs. 18.2%, p = 0.001). Preoperative shock was a strong predictor of mortality, with all affected patients succumbing to the illness (p < 0.001). The mean duration of surgery was 3.0 hours (SD = 0.0), and the mean perforation size was 0.8 cm (SD = 0.2). ICU admission was significantly associated with mortality (p < 0.001), with 90.9% of non-survivors requiring intensive care. Non-survivors had significantly longer hospital (9.7 vs. 8.2 days, p = 0.041) and ICU stays (4.3 vs. 2.2 days, p = 0.013), suggesting increased postoperative complications. The ASA classification was the strongest predictor of mortality (AUC = 0.893, p < 0.001), with higher ASA grades (III-V) significantly associated with death. The PULP (AUC = 0.727, p = 0.027) and Boey (AUC = 0.711, p = 0.039) scores also predicted mortality, with higher scores correlating with prolonged hospital stays. The PULP score showed a strong positive correlation with ICU (r = 0.676, p = 0.004) and hospital stay (r = 0.490, p = 0.001), while the Boey score was more strongly associated with hospital stay (r = 0.523, p < 0.001).

Conclusion: The study demonstrates that the ASA classification, PULP, and Boey scores are valuable tools for predicting the severity and outcomes of peptic ulcer perforation. Delayed presentation, preoperative shock, and ICU admission were strongly associated with increased mortality.