Ruptured Abdominal Aortic Aneurysm: Prediction of Mortality From Clinical Presentation and Glasgow Aneurysm Score

Weingarten, Toby N.; Thompson, Lauren T.; Licatino, Lauren K.; Bailey, Christopher H.; Schroeder, Darrell R.; Šprung, Juraj

doi:10.1053/j.jvca.2015.10.019

Cited by 8 publications

(4 citation statements)

References 19 publications

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“…Furthermore, diagnosis codes for major illnesses have been validated to have good sensitivity and specificity in these administrative claims data. 35 Also, the outcomes of patients with diagnoses of aortic complications in our study are consistent with modern series based on detailed clinical data, 36 further supporting the validity of the diagnosis codes used in our study, and our findings were similar in an analysis limited to patients with a documented aortic repair procedure. Third, our subgroup analyses should be interpreted with caution, because it is possible that only more severe cases of hypertension or connective tissue disease were documented, thereby inflating the apparent risks of aortic complications in these groups.…”

Section: Discussionsupporting

confidence: 89%

Pregnancy and the Risk of Aortic Dissection or Rupture

et al. 2016

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Background Case series have described aortic dissection and rupture in pregnancy. Few population-based data exist to support an association. Methods We performed a cohort-crossover study using data on all emergency department visits and acute care hospitalizations at nonfederal healthcare facilities in California, Florida, and New York. We included women ≥12 years of age with labor and delivery or abortive pregnancy outcome between 2005 and 2013. Our outcome was a composite of aortic dissection or rupture. Based on the timing of reported aortic complications during pregnancy, we defined the period of risk as 6 months before delivery until 3 months after delivery. We compared each patient's likelihood of aortic complications during this period to an equivalent 270-day period exactly 1 year later. Incidence rates and incidence rate ratios were computed using conditional Poisson regression with robust standard errors. Results Among 6,566,826 pregnancies in 4,933,697 women, we identified 36 cases of aortic dissection or rupture during the pregnancy or postpartum period and 9 cases during the control period 1 year later. The rate of aortic complications was 5.5 (95% confidence interval [CI], 4.0-7.8) per million patients during pregnancy and the postpartum period, compared with 1.4 (95% CI, 0.7-2.9) per million during the equivalent period 1 year later. Pregnancy was associated with a significantly increased risk of aortic dissection or rupture (incidence rate ratio, 4.0; 95% CI, 2.0-8.2) compared to the control period 1 year later. Conclusions The risk of aortic dissection or rupture is elevated during pregnancy and the postpartum period.

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Section: Discussionsupporting

confidence: 89%

Pregnancy and the Risk of Aortic Dissection or Rupture

et al. 2016

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“…The value of a mortality risk prediction tool for patients presenting with rAAA has been well-established and is evident by the number of mortality risk scores that have already been developed [5][6][7][8][9][10][11] and are a continued topic of discussion. [15][16][17][18] The previously developed scores are of restricted usefulness in the EVAR-first era for several reasons. The GAS and Hardman Index both failed to accurately predict mortality after rEVAR 12,13 and were especially limited when predicting mortality in the highest risk patients.…”

Section: Discussionmentioning

confidence: 99%

Accuracy evaluations of three ruptured abdominal aortic aneurysm mortality risk scores using an independent dataset

Hansen

Danaher

Starnes

et al. 2019

Journal of Vascular Surgery

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“…Weingarten et al [53] examined 125 patients (40 stable) and compared the association of presenting clinical acuity, defined an unstable patient as an individual with an rAAA and profound hypotension, preoperative cardiac arrest, loss of consciousness, and/or the need for preoperative tracheal intubation, and GAS. Therefore, this score may be qualified as a refined version of the GAS.…”

Section: Clinical Assessment Of Instability-weingarten Scorementioning

confidence: 99%

Risk Prediction Models for Peri-Operative Mortality in Patients Undergoing Major Vascular Surgery with Particular Focus on Ruptured Abdominal Aortic Aneurysms: A Scoping Review

Grandi,

Bertoglio,

Lepidi

et al. 2023

JCM

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Purpose. The present scoping review aims to describe and analyze available clinical data on the most commonly reported risk prediction indices in vascular surgery for perioperative mortality, with a particular focus on ruptured abdominal aortic aneurysm (rAAA). Materials and Methods. A scoping review following the PRISMA Protocols Extension for Scoping Reviews was performed. Available full-text studies published in English in PubMed, Cochrane and EMBASE databases (last queried, 30 March 2023) were systematically reviewed and analyzed. The Population, Intervention, Comparison, Outcome (PICO) framework used to construct the search strings was the following: in patients with aortic pathologies, in particular rAAA (population), undergoing open or endovascular surgery (intervention), what different risk prediction models exist (comparison), and how well do they predict post-operative mortality (outcomes)? Results. The literature search and screening of all relevant abstracts revealed a total of 56 studies in the final qualitative synthesis. The main findings of the scoping review, grouped by the risk score that was investigated in the original studies, were synthetized without performing any formal meta-analysis. A total of nine risk scores for major vascular surgery or elective AAA, and 10 scores focusing on rAAA, were identified. Whilst there were several validation studies suggesting that most risk scores performed adequately in the setting of rAAA, none reached 100% accuracy. The Glasgow aneurysm score, ERAS and Vancouver score risk scores were more frequently included in validation studies and were more often used in secondary studies. Unfortunately, the published literature presents a heterogenicity of results in the validation studies comparing the different risk scores. To date, no risk score has been endorsed by any of the vascular surgery societies. Conclusions. The use of risk scores in any complex surgery can have multiple advantages, especially when dealing with emergent cases, since they can inform perioperative decision making, patient and family discussions, and post hoc case-mix adjustments. Although a variety of different rAAA risk prediction tools have been published to date, none are superior to others based on this review. The heterogeneity of the variables used in the different scores impairs comparative analysis which represents a major limitation to understanding which risk score may be the “best” in contemporary practice. Future developments in artificial intelligence may further assist surgical decision making in predicting post-operative adverse events.

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Ruptured Abdominal Aortic Aneurysm: Prediction of Mortality From Clinical Presentation and Glasgow Aneurysm Score

Cited by 8 publications

References 19 publications

Pregnancy and the Risk of Aortic Dissection or Rupture

Pregnancy and the Risk of Aortic Dissection or Rupture

Accuracy evaluations of three ruptured abdominal aortic aneurysm mortality risk scores using an independent dataset

Risk Prediction Models for Peri-Operative Mortality in Patients Undergoing Major Vascular Surgery with Particular Focus on Ruptured Abdominal Aortic Aneurysms: A Scoping Review

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