PMID- 23182157
OWN - NLM
STAT- MEDLINE
DCOM- 20130314
LR  - 20211021
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Print)
IS  - 0741-5214 (Linking)
VI  - 57
IP  - 2
DP  - 2013 Feb
TI  - Derivation and validation of a practical risk score for prediction of mortality 
      after open repair of ruptured abdominal aortic aneurysms in a US regional cohort 
      and comparison to existing scoring systems.
PG  - 354-61
LID - S0741-5214(12)01942-8 [pii]
LID - 10.1016/j.jvs.2012.08.120 [doi]
AB  - OBJECTIVE: Scoring systems for predicting mortality after repair of ruptured 
      abdominal aortic aneurysms (RAAAs) have not been developed or tested in a United 
      States population and may not be accurate in the endovascular era. Using 
      prospectively collected data from the Vascular Study Group of New England 
      (VSGNE), we developed a practical risk score for in-hospital mortality after open 
      repair of RAAAs and compared its performance to that of the Glasgow aneurysm 
      score, Hardman index, Vancouver score, and Edinburg ruptured aneurysm score. 
      METHODS: Univariate analysis followed by multivariable analysis of patient, 
      prehospital, anatomic, and procedural characteristics identified significant 
      predictors of in-hospital mortality. Integer points were derived from the odds 
      ratio (OR) for mortality based on each independent predictor in order to generate 
      a VSGNE RAAA risk score, which was internally validated using bootstrapping 
      methodology. Discrimination and calibration of all models were assessed by 
      calculating the area under the receiver-operating characteristic curve 
      (C-statistic) and applying the Hosmer-Lemeshow test. RESULTS: From 2003 to 2009, 
      242 patients underwent open repair of RAAAs at 10 centers. In-hospital mortality 
      was 38% (n = 91). Independent predictors of mortality included age >76 years (OR, 
      5.3; 95% confidence interval [CI], 2.8-10.1), preoperative cardiac arrest (OR, 
      4.3; 95% CI, 1.6-12), loss of consciousness (OR, 2.6; 95% CI, 1.2-6), and 
      suprarenal aortic clamp (OR, 2.4; 95% CI, 1.3-4.6). Patient stratification 
      according to the VSGNE RAAA risk score (range, 0-6) accurately predicted 
      mortality and identified those at low and high risk for death (8%, 25%, 37%, 60%, 
      80%, and 87% for scores of 0, 1, 2, 3, 4, and >/=5, respectively). Discrimination 
      (C = .79) and calibration (chi(2) = 1.96; P = .85) were excellent in the derivation 
      and bootstrap samples and superior to that of existing scoring systems. The 
      Glasgow aneurysm score, Hardman index, Vancouver score, and Edinburg ruptured 
      aneurysm score correlated with mortality in the VSGNE cohort but failed to 
      identify accurately patients with a risk of mortality >65%. CONCLUSIONS: Existing 
      scoring systems predict mortality after RAAA repair in this cohort but do not 
      identify patients at highest risk. This parsimonious VSGNE RAAA risk score based 
      on four variables readily assessed at the time of presentation allows accurate 
      prediction of in-hospital mortality after open repair of RAAAs, including 
      identification of those patients at highest risk for postoperative mortality.
CI  - Copyright (c) 2013 Society for Vascular Surgery. Published by Mosby, Inc. All 
      rights reserved.
FAU - Robinson, William P
AU  - Robinson WP
AD  - Division of Vascular and Endovascular Surgery, University of Massachusetts 
      Medical School and UMass Memorial Medical Center, Worcester, MA 01655, USA. 
      William.Robinson@umassmemorial.org
FAU - Schanzer, Andres
AU  - Schanzer A
FAU - Li, Youfu
AU  - Li Y
FAU - Goodney, Philip P
AU  - Goodney PP
FAU - Nolan, Brian W
AU  - Nolan BW
FAU - Eslami, Mohammad H
AU  - Eslami MH
FAU - Cronenwett, Jack L
AU  - Cronenwett JL
FAU - Messina, Louis M
AU  - Messina LM
LA  - eng
GR  - K08 HL105676/HL/NHLBI NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Validation Study
DEP - 20121120
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
CIN - J Vasc Surg. 2013 Feb;57(2):361. PMID: 23337856
CIN - J Vasc Surg. 2013 Oct;58(4):1166. PMID: 24075113
CIN - J Vasc Surg. 2013 Oct;58(4):1166-7. PMID: 24075114
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Aneurysm, Abdominal/mortality/*surgery
MH  - Aortic Rupture/mortality/*surgery
MH  - Chi-Square Distribution
MH  - *Decision Support Techniques
MH  - Discriminant Analysis
MH  - Female
MH  - *Health Status Indicators
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - New England/epidemiology
MH  - Odds Ratio
MH  - Patient Selection
MH  - ROC Curve
MH  - Registries
MH  - Reproducibility of Results
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular Surgical Procedures/adverse effects/*mortality
PMC - PMC3773208
MID - NIHMS498681
COIS- Author conflict of interest: none.
EDAT- 2012/11/28 06:00
MHDA- 2013/03/15 06:00
PMCR- 2013/09/14
CRDT- 2012/11/28 06:00
PHST- 2012/07/05 00:00 [received]
PHST- 2012/08/22 00:00 [revised]
PHST- 2012/08/28 00:00 [accepted]
PHST- 2012/11/28 06:00 [entrez]
PHST- 2012/11/28 06:00 [pubmed]
PHST- 2013/03/15 06:00 [medline]
PHST- 2013/09/14 00:00 [pmc-release]
AID - S0741-5214(12)01942-8 [pii]
AID - 10.1016/j.jvs.2012.08.120 [doi]
PST - ppublish
SO  - J Vasc Surg. 2013 Feb;57(2):354-61. doi: 10.1016/j.jvs.2012.08.120. Epub 2012 Nov 
      20.