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Table 3 PPC diagnostic criteria—Melbourne Group Score Version 3

From: ICEAGE (Incidence of Complications following Emergency Abdominal surgery: Get Exercising): study protocol of a pragmatic, multicentre, randomised controlled trial testing physiotherapy for the prevention of complications and improved physical recovery after emergency abdominal surgery

When four or more of the following criteria* are present anytime in the 24-h period 00:01 to 24:00 on a single postoperative day:
 1. New abnormal breath sounds on auscultation different to preoperative assessment+
 2. Production of yellow, green, or brown sputum different to pre-morbid status+
 3. Pulse oximetry oxygen saturation (Sp02) < 90% on room air or FiO2 on 0.21 on more than one consecutive postoperative day**
 4. Raised maximum tympanic temperature ≥ 38 °C on more than one consecutive postoperative day
 5. Chest radiograph report of collapse/consolidation# ***
 6. Presence of infective organisms on sputum culture report***
 7. White cell count > 11 or < 3
 8. Physician’s diagnosis of postoperative pulmonary complication (e.g. atelectasis, pneumonia, AECOPD, respiratory failure, upper respiratory tract infection) OR prescription of an antibiotic specific for respiratory infection
  1. Abbreviations: PPC postoperative pulmonary complications, SpO2 pulse oximetry, FiO2 fraction of inspired oxygen, AECOPD acute exacerbation of chronic obstructive pulmonary disease, PEEP positive end expiratory pressure, CXR chest X-ray
  2. *If a blinded physiotherapist, nurse, or physician documents in the medical record the occurrence of a criterion, it can be taken as a positive finding. If no documentation present, a blinded assessor is required to assess this directly
  3. +If no preoperative assessment or documentation assume normal at baseline
  4. **For ventilated patients, if FiO2 ≥ 0.5 or PEEP ≥ 8, assume criterion 3 is present (do not alter FiO2), for all other patients set FiO2 to 0.21 and observe SpO2 for 2 min. If SpO2 drops below 90%, immediately reinstate previous FiO2. If not permissible to alter ventilation parameters, assume positive
  5. #If no written report for a CXR is available and a patient has three other positive signs, a masked senior physiotherapist or ward medical officer is to be contacted to report verbally on the available CXR
  6. ***When there are no daily measures of CXR or sputum sampling, carry over a positive finding to the next consecutive postoperative day