PREDICTION OF MORTALITY AND MORBIDITY IN PATIENTS WITH SECONDARY PERITONITIS USING POMPP VERSUS PULP SCORING SYSTEM

Abstract

Background: Secondary peritonitis is a common surgical emergency in low- and middle-income countries, with mortality rates ranging from 15% to 30%. Objective: To compare the predictive accuracy of the Peritonitis Mortality Prediction (POMPP) score and the Peptic Ulcer Perforation (PULP) score in patients with secondary peritonitis. Methods: This cross-sectional validation study was conducted at the North Surgical Ward, Department of Surgery, Mayo Hospital, Lahore, from 25 January 2025 to 5 June 2025, included 159 patients aged 18–75 years presenting with secondary peritonitis. POMPP and PULP scores were calculated for each patient. Patients were followed until discharge or death, and mortality outcomes were recorded. Results: The mean age of patients was 44.7 ± 13.2 years, with a male-to-female ratio of 1.9:1. The most frequent cause of peritonitis was perforated duodenal ulcer (39.6%), followed by appendicular perforation (21.4%) and typhoid ileal perforation (18.2%). The overall mortality rate was 21.4% (34/159). The POMPP score demonstrated higher sensitivity (85.3%), specificity (81.6%), NPV (93.4%), and overall diagnostic accuracy (82.9%) compared to the PULP score, which showed sensitivity of 72.1%, specificity of 76.4%, NPV of 87.2%, and accuracy of 75.5%. Conclusion: Both POMPP and PULP scores are effective in predicting mortality in patients with secondary peritonitis; however, POMPP outperformed PULP in this study and may be preferred as a simple, reliable bedside tool in resource-limited settings.