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Value of risk scores in the decision to palliate patients with ruptured abdominal aortic aneurysm

BACKGROUND: The aim of this study was to develop a 48‐h mortality risk score, which included morphology data, for patients with ruptured abdominal aortic aneurysm presenting to an emergency department, and to assess its predictive accuracy and clinical effectiveness in triaging patients to immediate...

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Autores principales: Sweeting, M. J., Ulug, P., Roy, J., Hultgren, R., Indrakusuma, R., Balm, R., Thompson, M. M., Hinchliffe, R. J., Thompson, S. G., Powell, J. T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055637/
https://www.ncbi.nlm.nih.gov/pubmed/30461007
http://dx.doi.org/10.1002/bjs.10820
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author Sweeting, M. J.
Ulug, P.
Roy, J.
Hultgren, R.
Indrakusuma, R.
Balm, R.
Thompson, M. M.
Hinchliffe, R. J.
Thompson, S. G.
Powell, J. T.
author_facet Sweeting, M. J.
Ulug, P.
Roy, J.
Hultgren, R.
Indrakusuma, R.
Balm, R.
Thompson, M. M.
Hinchliffe, R. J.
Thompson, S. G.
Powell, J. T.
author_sort Sweeting, M. J.
collection PubMed
description BACKGROUND: The aim of this study was to develop a 48‐h mortality risk score, which included morphology data, for patients with ruptured abdominal aortic aneurysm presenting to an emergency department, and to assess its predictive accuracy and clinical effectiveness in triaging patients to immediate aneurysm repair, transfer or palliative care. METHODS: Data from patients in the IMPROVE (Immediate Management of the Patient With Ruptured Aneurysm: Open Versus Endovascular Repair) randomized trial were used to develop the risk score. Variables considered included age, sex, haemodynamic markers and aortic morphology. Backwards selection was used to identify relevant predictors. Predictive performance was assessed using calibration plots and the C‐statistic. Validation of the newly developed and other previously published scores was conducted in four external populations. The net benefit of treating patients based on a risk threshold compared with treating none was quantified. RESULTS: Data from 536 patients in the IMPROVE trial were included. The final variables retained were age, sex, haemoglobin level, serum creatinine level, systolic BP, aortic neck length and angle, and acute myocardial ischaemia. The discrimination of the score for 48‐h mortality in the IMPROVE data was reasonable (C‐statistic 0·710, 95 per cent c.i. 0·659 to 0·760), but varied in external populations (from 0·652 to 0·761). The new score outperformed other published risk scores in some, but not all, populations. An 8 (95 per cent c.i. 5 to 11) per cent improvement in the C‐statistic was estimated compared with using age alone. CONCLUSION: The assessed risk scores did not have sufficient accuracy to enable potentially life‐saving decisions to be made regarding intervention. Focus should therefore shift to offering repair to more patients and reducing non‐intervention rates, while respecting the wishes of the patient and family.
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spelling pubmed-60556372018-07-23 Value of risk scores in the decision to palliate patients with ruptured abdominal aortic aneurysm Sweeting, M. J. Ulug, P. Roy, J. Hultgren, R. Indrakusuma, R. Balm, R. Thompson, M. M. Hinchliffe, R. J. Thompson, S. G. Powell, J. T. Br J Surg Original Articles BACKGROUND: The aim of this study was to develop a 48‐h mortality risk score, which included morphology data, for patients with ruptured abdominal aortic aneurysm presenting to an emergency department, and to assess its predictive accuracy and clinical effectiveness in triaging patients to immediate aneurysm repair, transfer or palliative care. METHODS: Data from patients in the IMPROVE (Immediate Management of the Patient With Ruptured Aneurysm: Open Versus Endovascular Repair) randomized trial were used to develop the risk score. Variables considered included age, sex, haemodynamic markers and aortic morphology. Backwards selection was used to identify relevant predictors. Predictive performance was assessed using calibration plots and the C‐statistic. Validation of the newly developed and other previously published scores was conducted in four external populations. The net benefit of treating patients based on a risk threshold compared with treating none was quantified. RESULTS: Data from 536 patients in the IMPROVE trial were included. The final variables retained were age, sex, haemoglobin level, serum creatinine level, systolic BP, aortic neck length and angle, and acute myocardial ischaemia. The discrimination of the score for 48‐h mortality in the IMPROVE data was reasonable (C‐statistic 0·710, 95 per cent c.i. 0·659 to 0·760), but varied in external populations (from 0·652 to 0·761). The new score outperformed other published risk scores in some, but not all, populations. An 8 (95 per cent c.i. 5 to 11) per cent improvement in the C‐statistic was estimated compared with using age alone. CONCLUSION: The assessed risk scores did not have sufficient accuracy to enable potentially life‐saving decisions to be made regarding intervention. Focus should therefore shift to offering repair to more patients and reducing non‐intervention rates, while respecting the wishes of the patient and family. John Wiley & Sons, Ltd 2018-04-06 2018-08 /pmc/articles/PMC6055637/ /pubmed/30461007 http://dx.doi.org/10.1002/bjs.10820 Text en © 2018 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Articles
Sweeting, M. J.
Ulug, P.
Roy, J.
Hultgren, R.
Indrakusuma, R.
Balm, R.
Thompson, M. M.
Hinchliffe, R. J.
Thompson, S. G.
Powell, J. T.
Value of risk scores in the decision to palliate patients with ruptured abdominal aortic aneurysm
title Value of risk scores in the decision to palliate patients with ruptured abdominal aortic aneurysm
title_full Value of risk scores in the decision to palliate patients with ruptured abdominal aortic aneurysm
title_fullStr Value of risk scores in the decision to palliate patients with ruptured abdominal aortic aneurysm
title_full_unstemmed Value of risk scores in the decision to palliate patients with ruptured abdominal aortic aneurysm
title_short Value of risk scores in the decision to palliate patients with ruptured abdominal aortic aneurysm
title_sort value of risk scores in the decision to palliate patients with ruptured abdominal aortic aneurysm
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055637/
https://www.ncbi.nlm.nih.gov/pubmed/30461007
http://dx.doi.org/10.1002/bjs.10820
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