Predicting Outcome in Ruptured Abdominal Aortic Aneurysm: A Prospective Study of 100 Consecutive Cases

Abstract

The scoring system accurately predicted operative mortality. The score was available in the majority of cases and may help the surgeon give informed consent to patients and relatives prior to surgical intervention.

Usefulness of the Hardman index in predicting outcome after endovascular repair of ruptured abdominal aortic aneurysms

“…2,6,[8][9][10][11][12][13]16,17 These figures confirm the significant predictive effect of the index but also its failure to consistently identify a subgroup of patients with 100% mortality in which surgery should be withheld. The authors of the meta-analysis speculated that the utility of the index seemed to be impeded by variability in scoring resulting from missing or nondiagnostic data, particularly with regards to ECG.…”

“…2,[8][9][10] Subsequent studies, however, yielded inconsistent results. 6,[11][12][13][14][15][16][17] Some found the index to be a poor predictor and failed to show a statistical association with death, 12-14 whereas others found a strong correlation.…”

Prognostic scoring in ruptured abdominal aortic aneurysm: A prospective evaluation

“…17 Ten series have examined the validity of the Hardman Index; only one has been prospective. 3,8,9,13,16,[18][19][20][21][22] Initial reports and consensus was that the Hardman Index accurately predicted death after ruptured AAA. The presence of three or more variables was widely held to be fatal 8,9 ; however, more recent data have shown that the instrument 73 107 0 41 70 1 2 Cardiac dysfunction, suprarenal AAA 79 96 1 38 67 1 3 Cardiac dysfunction, chronic renal failure 83 121 3 88 91 2 4 Cardiac dysfunction 87 111 4 88 91 3 5 Cardiac dysfunction, chronic renal failure 89 120 3 57 77 2 6 Severe COPD 80 97 1 31 63 1 7 Previous disabling stroke 71 120 2 79 87 2 8 Pre-existing severe brain injury 76 100 1 31 63 2 9…”

“…22 Indeed, in the only other reported prospective study, data were missing on almost a third of patients. 9 The POSSUM score is a tool that was designed to support comparative audit. It is important to recognize that it has never been recommended for outcome prediction.…”

“…It has been reported that the presence of Ն3 variables is uniformly fatal. 8,9 The POSSUM represents a risk-prediction model based on a physiology score derived from 12 preoperative variables, independently predictive of adverse postoperative outcome on multivariate analysis, and an operative score derived from six further intraoperative variables. To allow for preoperative risk scoring, the physiology score may be subjected to risk equations developed for vascular surgery (V-POSSUM) and ruptured AAA (RAAA-POSSUM) that convert the scores into a predicted percentage mortality (Table I).…”