Prognostic scoring in ruptured abdominal aortic aneurysm

A prospective evaluation

Andrew L. Tambyraja, Amanda J. Lee, John A. Murie, Roderick T. A. Chalmers

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background: Prospective validation of prognostic scoring systems for ruptured abdominal aortic aneurysm (AAA) is lacking. This study assesses the validity of three established risk scores and a new prognostic index.

Method: Patients admitted with ruptured AAA during a 26-month period (August 2002-December 2004) were recruited prospectively. The Glasgow Aneurysm Score (GAS), Hardman Index, Physiological and Operative Severity Score for enumeration of Mortality and Morbidity (POSSUM) scores, and the Edinburgh Ruptured Aneurysm Score (ERAS) were recorded and related to outcome.

Results: During the study period, 111 patients were admitted with ruptured AAA. Of these, 84 (76%) underwent attempted operative repair and were included in the study; 37 (44%) died after operation. The GAS, Hardman Index, and the ERAS were statistically related to mortality. However, analysis by receiver-operator characteristic curve revealed the ERAS to have an area under the curve (AUC) of 0.72 (95% confidence interval [CI], 0.61-0.83). The vascular (V)-POSSUM and ruptured AAA (RAAA)-POSSUM models had an AUC of 0.70 (95% CI, 0.59-0.82). The Hardman Index and GAS had an AUC of 0.69 (95% CI, 0.57-0.80) and 0.64 (95% CI, 0.52-0.76), respectively. Although the V-POSSUM equation predicted mortality effectively (P =.086), the RAAA-POSSUM derivative demonstrated a significant lack of fit (P =.009).

Conclusion: Prospective validation shows that the Hardman Index, GAS, and V-POSSUM and RAAA-POSSUM scores do not perform well as predictors for death after ruptured AAA. The ERAS accurately stratifies perioperative risk but requires further validation.

Original languageEnglish
Pages (from-to)282-286
Number of pages5
JournalJournal of Vascular Surgery
Volume47
Issue number2
Early online date29 Jan 2008
DOIs
Publication statusPublished - Feb 2008

Keywords

  • Hardman Index
  • Portsmouth possum
  • surgery
  • repair

Cite this

Prognostic scoring in ruptured abdominal aortic aneurysm : A prospective evaluation. / Tambyraja, Andrew L.; Lee, Amanda J.; Murie, John A.; Chalmers, Roderick T. A.

In: Journal of Vascular Surgery, Vol. 47, No. 2, 02.2008, p. 282-286.

Research output: Contribution to journalArticle

Tambyraja, Andrew L. ; Lee, Amanda J. ; Murie, John A. ; Chalmers, Roderick T. A. / Prognostic scoring in ruptured abdominal aortic aneurysm : A prospective evaluation. In: Journal of Vascular Surgery. 2008 ; Vol. 47, No. 2. pp. 282-286.
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abstract = "Background: Prospective validation of prognostic scoring systems for ruptured abdominal aortic aneurysm (AAA) is lacking. This study assesses the validity of three established risk scores and a new prognostic index.Method: Patients admitted with ruptured AAA during a 26-month period (August 2002-December 2004) were recruited prospectively. The Glasgow Aneurysm Score (GAS), Hardman Index, Physiological and Operative Severity Score for enumeration of Mortality and Morbidity (POSSUM) scores, and the Edinburgh Ruptured Aneurysm Score (ERAS) were recorded and related to outcome.Results: During the study period, 111 patients were admitted with ruptured AAA. Of these, 84 (76{\%}) underwent attempted operative repair and were included in the study; 37 (44{\%}) died after operation. The GAS, Hardman Index, and the ERAS were statistically related to mortality. However, analysis by receiver-operator characteristic curve revealed the ERAS to have an area under the curve (AUC) of 0.72 (95{\%} confidence interval [CI], 0.61-0.83). The vascular (V)-POSSUM and ruptured AAA (RAAA)-POSSUM models had an AUC of 0.70 (95{\%} CI, 0.59-0.82). The Hardman Index and GAS had an AUC of 0.69 (95{\%} CI, 0.57-0.80) and 0.64 (95{\%} CI, 0.52-0.76), respectively. Although the V-POSSUM equation predicted mortality effectively (P =.086), the RAAA-POSSUM derivative demonstrated a significant lack of fit (P =.009).Conclusion: Prospective validation shows that the Hardman Index, GAS, and V-POSSUM and RAAA-POSSUM scores do not perform well as predictors for death after ruptured AAA. The ERAS accurately stratifies perioperative risk but requires further validation.",
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AU - Chalmers, Roderick T. A.

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N2 - Background: Prospective validation of prognostic scoring systems for ruptured abdominal aortic aneurysm (AAA) is lacking. This study assesses the validity of three established risk scores and a new prognostic index.Method: Patients admitted with ruptured AAA during a 26-month period (August 2002-December 2004) were recruited prospectively. The Glasgow Aneurysm Score (GAS), Hardman Index, Physiological and Operative Severity Score for enumeration of Mortality and Morbidity (POSSUM) scores, and the Edinburgh Ruptured Aneurysm Score (ERAS) were recorded and related to outcome.Results: During the study period, 111 patients were admitted with ruptured AAA. Of these, 84 (76%) underwent attempted operative repair and were included in the study; 37 (44%) died after operation. The GAS, Hardman Index, and the ERAS were statistically related to mortality. However, analysis by receiver-operator characteristic curve revealed the ERAS to have an area under the curve (AUC) of 0.72 (95% confidence interval [CI], 0.61-0.83). The vascular (V)-POSSUM and ruptured AAA (RAAA)-POSSUM models had an AUC of 0.70 (95% CI, 0.59-0.82). The Hardman Index and GAS had an AUC of 0.69 (95% CI, 0.57-0.80) and 0.64 (95% CI, 0.52-0.76), respectively. Although the V-POSSUM equation predicted mortality effectively (P =.086), the RAAA-POSSUM derivative demonstrated a significant lack of fit (P =.009).Conclusion: Prospective validation shows that the Hardman Index, GAS, and V-POSSUM and RAAA-POSSUM scores do not perform well as predictors for death after ruptured AAA. The ERAS accurately stratifies perioperative risk but requires further validation.

AB - Background: Prospective validation of prognostic scoring systems for ruptured abdominal aortic aneurysm (AAA) is lacking. This study assesses the validity of three established risk scores and a new prognostic index.Method: Patients admitted with ruptured AAA during a 26-month period (August 2002-December 2004) were recruited prospectively. The Glasgow Aneurysm Score (GAS), Hardman Index, Physiological and Operative Severity Score for enumeration of Mortality and Morbidity (POSSUM) scores, and the Edinburgh Ruptured Aneurysm Score (ERAS) were recorded and related to outcome.Results: During the study period, 111 patients were admitted with ruptured AAA. Of these, 84 (76%) underwent attempted operative repair and were included in the study; 37 (44%) died after operation. The GAS, Hardman Index, and the ERAS were statistically related to mortality. However, analysis by receiver-operator characteristic curve revealed the ERAS to have an area under the curve (AUC) of 0.72 (95% confidence interval [CI], 0.61-0.83). The vascular (V)-POSSUM and ruptured AAA (RAAA)-POSSUM models had an AUC of 0.70 (95% CI, 0.59-0.82). The Hardman Index and GAS had an AUC of 0.69 (95% CI, 0.57-0.80) and 0.64 (95% CI, 0.52-0.76), respectively. Although the V-POSSUM equation predicted mortality effectively (P =.086), the RAAA-POSSUM derivative demonstrated a significant lack of fit (P =.009).Conclusion: Prospective validation shows that the Hardman Index, GAS, and V-POSSUM and RAAA-POSSUM scores do not perform well as predictors for death after ruptured AAA. The ERAS accurately stratifies perioperative risk but requires further validation.

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KW - Portsmouth possum

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KW - repair

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SP - 282

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JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 2

ER -