Risk Stratification Tools and Scoring Systems in Perforated Viscus: A Systematic Review.

Perforated viscus remains a high-risk surgical emergency with significant mortality despite advances in perioperative care. Accurate risk stratification is essential to guide triage, surgical decision-making, and postoperative management. The available scoring tools are the Boey score (three-variable risk model: shock, comorbidity, delay >24 hours), Peptic Ulcer Perforation (PULP) score, Mannheim Peritonitis Index (MPI), Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM), and Acute Physiology and Chronic Health Evaluation II (APACHE-II), each addressing different dimensions of patient risk, ranging from physiological stability to intra-abdominal severity. Simpler models such as Boey and MPI are valuable in emergency and resource-limited settings due to their bedside applicability. In contrast, PULP and APACHE-II offer greater precision by integrating systemic comorbidities and biochemical indices, making them more suitable for tertiary centers. POSSUM provides a balanced approach by combining physiology with operative severity, though it may overestimate mortality. No single model is universally applicable, highlighting the need for context-specific use. Future research should focus on hybrid scoring systems that merge clinical simplicity with modern predictive analytics for broader global relevance.