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Official Journal of the Italian Society of Orthopaedics and Traumatology

Table 1 Physiological and operative severity assessment in the orthopaedic POSSUM system

From: Neck of femur fractures in the over 90s: a select group of patients who require prompt surgical intervention for optimal results

 

Physiologic ill score

 

Operative severity score

 

1

2

4

8

 

1

2

4

8

Age (years)

<60

61–70

>71

 

Magnitude

Minor

Inter

Major

Major+

Cardiac signs

Normal

On cardiac drugs or steroid

Oedema Warfarin

Raised JVPa

Number of operative variables within 30 days

1

 

2

>2

Chest radiograph

Normal

 

Borderline cardiomegaly

Cardiomegaly

Blood loss per operation (ml)

<100

101–500

501–999

>1,000

Resp signs

Normal

SOBb exertion

SOB stairs

SOB rest

Contamination

None

Incised would, i.e. stab

Minor contamination or necrotic tissue

Gross contamination or necrotic tissue

Chest radiograph

Normal

Mild COADc

Mod COAD

Any other change

Presence of malignancy

None

l0

Node metastases

Distant metastases

Systolic BP (mmHg)

110–130

131–170

100–109

>171

90–99

<89

Timing of operation

Elective

 

Emergency Resuscitation possible <48 h

Emergency Immediate <6 h

Pulse (/min)

50–80

81–100

40–49

101–120

>121

<39

     

Como score

15

12–14

9–11

<8

     

Blood urea (mmol/1)

<7.5

7.6–10

10.1–15

>15.1

     

Blood Na (mmol/1)

>136

131–135

126–130

<125

     

Blood K (mmol/l)

3.5–5

3.2–3.4

5.1–5.3

2.9–3.1

5.4–5.9

<2.8

>6

     

Hb (g/100 ml)

13–16

11–12.9

16.1 to 17

10–11.4

17.1–18

<9.9

>18.1

     

White cell count (×1012/1)

4–10

10.1–20

3.1–3.9

>20.l

<3

      

ECG

Normal

 

AFd (60–90)

Any other change

     
  1. aJugular venous pressure
  2. bShortness of breath
  3. cChronic obstructive airways disease
  4. dArtrial fibrillation