A systematic review of surgical infection scoring systems used in surgical patients

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Executive summaryBackgroundSurgical site infection is an acute wound infection developed at the surgical site within 30 days following surgery. Having a valid, reliable and sensitive scoring system to assess the signs and symptoms of surgical site infection can allow prompt treatment as well as evaluation of its management. This review undertook a comprehensive search on available scoring systems to assess for surgical site infection. Only one scoring system, ASEPSIS, met the inclusion criteria of this review. It is an acronym for Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria and Stay as inpatient prolonged over fourteen days.ObjectiveThe overall objective of this review was to measure the validity, reliability and sensitivity of available scoring systems used to assess surgical site infections.Inclusion CriteriaTypes of participantsSurgical patients 18 years of age or more.Types of interventionsComparing the use of ASEPSIS scoring system with other definitions and criteria in the assessment of surgical wounds.Types of outcome measuresValidity, reliability and sensitivity of the surgical infection scoring systems in assessing infection.Types of studiesAll studies using scoring systems to assess for surgical site infection in surgical settings were considered.Search strategyThe search strategy for identification of studies targeted published papers in the English language. All relevant studies dated between 1980 till 2010 were considered.Assessment of methodological qualityThe studies were evaluated by two independent reviewers using a critical appraisal instrument. Two reviewers made independent assessments of each study with reference to the selection criteria.Data extractionData extracted included specific details about the phenomena of interest, population, study methods and outcomes of significance to the review question and specific objectives.Data synthesisThere were five studies included in the review as the ASEPSIS scoring system was the only scoring tool that met the inclusion criteria. One study discussed the development of the ASEPSIS scoring system, two studies were on the reliability, one study on the sensitivity and the final on the comparison of the ASEPSIS scoring system with other SSI criteria and definition. Due to variation in study designs, the findings were summarised and presented in a narrative format.ResultsThe ASEPSIS scoring system, derived from post cardiac surgery, was the only established referenced scoring system to assess for SSI. Validity and sensitivity of this scoring system were not established in assessing sternal related wounds. However, reliability was reported to be good. Validity and reliability were not established in assessing non sternal surgical sites. Sensitivity level was reported for non sternal surgical sites but its reliability level declined as the severity of infection worsened.ConclusionThis review revealed that there are limited choices of scoring systems to assess different surgical sites for SSI. Currently, only ASEPSIS scoring system is available and it is not validated except for use with sternal wounds and therefore should be used with caution when assessing for non sternal surgical sites infection.Implication for ResearchThis review has raised questions about the use of ASEPSIS scoring system to assess non sternal SSI. Further research to identify a valid scoring system for this purpose is required.Implication for PracticeDoctors and nurses should be careful when using ASEPSIS scoring system to assess surgical site infection.

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