Boey score (perforated peptic ulcer)
Operative mortality risk in perforated peptic ulcer
Sources last checked: 2026-10-13
Boey score (perforated peptic ulcer)
Operative mortality risk in perforated peptic ulcer
Mortality 0 % in the prospective validation (n = 259).
Derived in a 1980s Hong Kong series of duodenal perforations, when definitive ulcer surgery was common. Modern series show lower mortality per class; the PULP score is an alternative.
Interpretation
| 0 factors | Mortality 0 % in the prospective validation (n = 259). |
|---|---|
| 1 factor | Mortality 10 %. |
| 2 factors | Mortality 45.5 %. |
| 3 factors | Mortality 100 % in the original series. |
What is the Boey score (perforated peptic ulcer)?
The Boey score predicts operative mortality in perforated peptic ulcer from three factors: major medical illness, preoperative shock and perforation longer than 24 hours. Boey and colleagues validated it prospectively in 1987 in 259 patients with perforated duodenal ulcer in Hong Kong. Mortality was 0 %, 10 %, 45.5 % and 100 % with none, one, two or three factors.
When to use it
- Preoperative risk assessment in perforated gastric or duodenal ulcer
- Discussing prognosis with patients and families
- Selecting patients for non-operative or minimal surgical strategies in research
When not to use it
- Other causes of perforation (colonic, small bowel) — use peritonitis scores
- As the sole reason to withhold surgery
How it is calculated
| Criterion | Points |
|---|---|
| Major medical illness (e.g. significant cardiopulmonary, renal, hepatic disease, diabetes, malignancy) | +1 |
| Preoperative shock (systolic BP < 100 mmHg) | +1 |
| Perforation for more than 24 hours | +1 |
Clinical pearls and limitations
- Derived in a 1980s Hong Kong series of duodenal perforations, when definitive ulcer surgery was common. Modern series show lower mortality per class; the PULP score is an alternative.
- Shock is defined as systolic blood pressure below 100 mmHg before surgery.
- Time from perforation is often uncertain; take the onset of sudden severe pain as the start.
- In modern series the absolute mortality per class is lower; the relative gradient remains useful.
Frequently asked questions
What are the three Boey risk factors?
Major medical illness, preoperative shock (systolic BP < 100 mmHg) and perforation for more than 24 hours.
What is the mortality with a Boey score of 2?
45.5 % in the original 1987 series.
Is Boey better than PULP?
Both discriminate reasonably; PULP includes more variables. Boey is quicker to apply at the bedside.
Evidence and guidelines
- Primary source: Boey J, Choi SK, Poon A, Alagaratnam TT. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg 1987;205(1):22-26 (mortality 0 %, 10 %, 45.5 %, 100 % from the abstract).
- Tarasconi A et al. Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg 2020;15:3.
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