Prognostic scoring in ruptured abdominal aortic aneurysm: A prospective evaluation

Abstract

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.

Do Scoring Systems Help in Predicting Survival Following Ruptured Abdominal Aortic Aneurysm Surgery?

“…When using statistical models, clinicians need to appreciate that results may support, but can never replace, clinical judgement. In agreement with current literature, 28,29 our results suggest that the Glasgow Aneurysm Score and Hardman Index are poor predictors of outcome after rAAA surgery and more accurate models need to be developed.…”

Editor's Choice - External Validation of Models Predicting Survival After Ruptured Abdominal Aortic Aneurysm Repair

“…These results are in conflict with one validation study with sufficiently accurate discrimination, 25 but in accordance with another validation study with insufficiently accurate discrimination. 23 Concerning calibration, one previous validation reported an observed death rate of 50% in patients with a predicted death rate of 80% (estimated from figure).…”

Comparación de modelos de riesgo para reparación endovascular y abierta por rotura de aneurisma aórtico abdominal

“…En un metaanálisis realizado en 2007 para la validación del índice de Hardman y de los modelos GAS, POSSUM y Vancouver scoring system, ninguno de los modelos mostró concordancia ni validez absoluta 22 . Finalmente, en el análisis de un registro prospectivo de 84 pacientes con AAAr, en los que se observó una mortalidad del 44%, la evaluación de los modelos GAS, V-POSSUM, AAAR-POSSUM, ERAS y del índice de Hardman, mostró que estos no eran un buen método para la predicción de la mortalidad después del tratamiento del AAAr, a excepción del ERAS, con un valor del AUC de 0,72 23 . En nuestro medio, Merino et al describieron un valor pronóstico del GAS con un AUC de 0,814 (intervalo de confianza, IC 95%: 0,725-0,883) y punto de corte en 106 puntos (sensibilidad 45,1%; especificidad 94,2%; VPP: 88,5%; VPN: 63,6%) en una serie retrospectiva de 103 pacientes 25 .…”