The feasibility and efficacy of the Position Acute Tone External system score in evaluating hemorrhoid severity and guiding clinical treatment

[Objectives] To analyze the feasibility and efficacy of the Position Acute Tone External (PATE) system score in evaluating hemorrhoid severity and guiding clinical treatment. [Methods] This cross-sectional study conducted a questionnaire survey among patients with hemorrhoids in outpatient/ward settings at six anorectal centers from November 2021 to November 2022. The questionnaire, designed by our research team, included demographic information, PATE system score, patient self-evaluation of hemorrhoid severity using the Visual Analog Scale (VAS), patient self-evaluation of hemorrhoid symptoms (prolapse, hematochezia, anal pain, perianal pruritus, anal dampness, and soiling of pants) severity using the VAS, and patient quality of life score using the Chinese version of the HEMO-FISS-Quality of Life Questionnaire. The implementation of the PATE system score was analyzed, and comparisons of the PATE system score were made among/between with different Goligher grades and treatments (medication or surgery). The correlation between the PATE system score and patient self-evaluation of hemorrhoid severity score was also analyzed. The efficacy of the PATE system score in predicting the need for surgery was analyzed using the Receiver Operating Characteristic (ROC) curve, and the optimal cut-off value for the PATE system score was determined. Patients were grouped based on this optimal cut-off value, and comparisons were made between different PATE system score groups regarding patient self-evaluation of hemorrhoid symptoms severity, patient quality of life score, and the proportion of patients receiving medication or surgery. [Results] A total of 623 questionnaires were collected (response rate: 88.1%). Complete Goligher grades data were available for 615 patients. There was a statistically significant difference in PATE system score of overall comparison among patients with Goligher grades I-IV (P<0.05). Patients undergoing surgery had higher PATE system score than those receiving medication, with a statistically significant difference (P<0.05). The correlation coefficient between the PATE system score and patient self-evaluation of hemorrhoid severity score was 0.736 (P<0.001). The area under the ROC curve in predicting the need for surgery based on the PATE system score was 0.755 (95%CI: 0.716-0.793), with an optimal cut-off value of 18.45, sensitivity of 0.644, and specificity of 0.794. Based on clinical scoring, patients were divided into a low-score group (PATE system score≤18) and a high-score group (PATE system score≥19). There were statistically significant differences between the two groups regarding patient self-evaluation of hemorrhoid symptoms severity, all dimensions and total score of the Chinese version of the HEMO-FISS-Quality of Life Questionnaire, and the proportion of patients receiving medication or surgery (P<0.05). [Conclusion] The PATE system score effectively reflects hemorrhoid severity and could provide reference information for clinical treatment planning. Patients with a PATE system score of 19 or higher should be considered for upfront surgery.