In prior times, the surgeon on rounds would stand at the bedside and observe a lemon-yellow patient awaiting an urgent abdominal operation and proclaim, “He’s gonna die.” Although this judgment was wholly subjective, it was rarely incorrect. Subsequently, systems such as the Child and CTP classifications appeared, but these also suffered from subjectivity. The problem with all such predictors of death was that they did exactly that but provided the surgeon with little guidance in the way of therapeutic interventions by which to thwart the anticipated outcome.
Pickleman J. The Safety of Intra-abdominal Surgery in Patients With Cirrhosis—Invited Critique. Arch Surg. 2005;140(7):655. doi:10.1001/archsurg.140.7.655
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