Value of risk scores in the decision to palliate patients with ruptured abdominal aortic aneurysm. BJS 2018; 105: 1135-1144.
Published: 6th April 2018
Authors: M. J. Sweeting, P. Ulug, J. Roy, R. Hultgren, R. Indrakusuma, R. Balm et al.
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.
Data from patients in the IMPROVE (Immediate Management of the Patient With Ruptured Aneurysm: Open
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.
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.Full text
You may also be interested in
Population‐based study of mortality and major amputation following lower limb revascularization. BJS 2018; 105: 1145-1154.
Authors: K. Heikkila, I. M. Loftus, D. C. Mitchell, A. S. Johal, S. Waton, D. A. Cromwell et al.
Notes: lower than previously estimated
Cost‐effectiveness of population‐based vascular disease screening and intervention in men from the Viborg Vascular (VIVA) trial.
Authors: R. Søgaard, J. S. Lindholt
Notes: Highly cost effective
Five‐year follow‐up of a randomized clinical trial comparing open surgery, foam sclerotherapy and endovenous laser ablation for great saphenous varicose veins. BJS 2018; 105: 686-691.
Authors: S. Vähäaho, K. Halmesmäki, A. Albäck, E. Saarinen, M. Venermo
Notes: More foam recurrences
Eight‐year follow‐up of a randomized clinical trial comparing ultrasound‐guided foam sclerotherapy with surgical stripping of the great saphenous vein. BJS 2018; 105: 692-698.
Authors: Y. L. Lam, J. A. Lawson, I. M. Toonder, N. H. Shadid, A. Sommer, M. Veenstra et al.
Notes: Surgery better
Follow‐up after endovascular aortic aneurysm repair can be stratified based on first postoperative imaging. BJS 2018; 105: 709-718.
Authors: H. Baderkhan, O. Haller, A. Wanhainen, M. Björck, K. Mani
Notes: Short sealing zones spell trouble
Risk of major amputation in patients with intermittent claudication undergoing early revascularization. BJS 2018; 105: 699-708.
Authors: J. Golledge, J. V. Moxon, S. Rowbotham, J. Pinchbeck, L. Yip, R. Velu et al.
Notes: Early revascularization associated with amputation
Authors: R. E. Clough, R. Spear, K. Van Calster, A. Hertault, R. Azzaoui, J. Sobocinski et al.
Notes: Encouraging results in expert hands
Authors: N. Rudarakanchana, M. P. Jenkins
Notes: Formidable challenge
Cellular and molecular imaging of the arteries in the age of precision medicine. BJS 2018; 105: 311-312.
Authors: R. O. Forsythe, D. E. Newby
Comparative analysis of the outcomes of elective abdominal aortic aneurysm repair in England and Sweden. BJS 2018; 105: 520-528.
Authors: A. Karthikesalingam, M. J. Grima, P. J. Holt, A. Vidal‐Diez, M. M. Thompson, A. Wanhainen et al.
Notes: Improving in England
Participation in bowel screening among men attending abdominal aortic aneurysm screening. BJS 2018; 105: 529-534.
Authors: A. J. Quyn, C. G. Fraser, J. Rodger, A. Digan, A. S. Anderson, R. J. C. Steele et al.
Notes: Maximizing screening benefits
Cerebral embolization, silent cerebral infarction and neurocognitive decline after thoracic endovascular aortic repair. BJS 2018; 105: 366-378.
Authors: A. H. Perera, N. Rudarakanchana, L. Monzon, C. D. Bicknell, B. Modarai, O. Kirmi et al.
Notes: Occurs in most