Evaluation of five different aneurysm scoring systems to predict mortality in ruptured abdominal aortic aneurysm patients

Abstract Background Ruptured abdominal aortic aneurysms (RAAAs) are associated with a high overall mortality (up to 25% to 35%) ≤30 days when offered surgical treatment. Risk prediction models can provide valuable information on surgical risks, guide clinical decision making, and help identify patie...

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Veröffentlicht in:Journal of vascular surgery 2016-12, Vol.64 (6), p.1609-1616
Hauptverfasser: Vos, Cornelis G., MD, PhD, de Vries, Jean-Paul P.M., MD, PhD, Werson, Debora A.B., MPA, van Dongen, Eric P.A., MD, PhD, Schreve, Michiel A., MD, Ünlü, Çağdaş, MD, PhD
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container_end_page 1616
container_issue 6
container_start_page 1609
container_title Journal of vascular surgery
container_volume 64
creator Vos, Cornelis G., MD, PhD
de Vries, Jean-Paul P.M., MD, PhD
Werson, Debora A.B., MPA
van Dongen, Eric P.A., MD, PhD
Schreve, Michiel A., MD
Ünlü, Çağdaş, MD, PhD
description Abstract Background Ruptured abdominal aortic aneurysms (RAAAs) are associated with a high overall mortality (up to 25% to 35%) ≤30 days when offered surgical treatment. Risk prediction models can provide valuable information on surgical risks, guide clinical decision making, and help identify patients who should not be operated on to prevent futile surgery. Finally, they can be used to evaluate clinical outcome. Different aneurysm scores are available. New ones (with only four parameters) are being developed, such as the Dutch Aneurysm Score (DAS). This study analyzed and compared these scoring models. Methods The study selected consecutive patients who presented with RAAA in two large vascular centers (Medisch Centrum Alkmaar and St. Antonius Nieuwegein) between 2005 and 2015. Variables necessary to retrospectively evaluate the scoring systems were registered in the patients' medical files. The discriminatory power and calibration were assessed using the receiver operating characteristic curve and the Hosmer-Lemeshow χ2 test. Results The study included 347 consecutive patients with RAAA. There were 298 men (85.9%), and the mean ± standard deviation age was 72.6 ± 8.1 years. The receiver operating characteristic curves were developed for the DAS, Glasgow Aneurysm Score (GAS), Edinburgh Ruptured Aneurysm Score, Vancouver Scoring System (VSS), and Hardman Index. The area under the curve was better for the VSS (0.716; 95% confidence interval [CI], 0.647-0.786) than for the other scoring systems. Areas under the curve for the DAS (0.664; 95% CI, 0.592-0.736), Hardman Index (0.664; 95% CI, 0.592-0.736), Edinburgh Ruptured Aneurysm Score (0.621; 95% CI, 0.543-0.700), and GAS (0.591; 95% CI, 0.517-0.665) were slightly smaller, although only the difference between the VSS and GAS was statistically significant. Calibration showed a good fit for all models. Conclusions The performance of the tested models for the prediction of mortality in RAAA patients was comparable, with only a statistically significant difference between the VSS and the GAS in favor of the VSS. However, an almost perfect prediction is needed to withhold intervention, and no existing scoring system is capable of that.
doi_str_mv 10.1016/j.jvs.2016.05.099
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Risk prediction models can provide valuable information on surgical risks, guide clinical decision making, and help identify patients who should not be operated on to prevent futile surgery. Finally, they can be used to evaluate clinical outcome. Different aneurysm scores are available. New ones (with only four parameters) are being developed, such as the Dutch Aneurysm Score (DAS). This study analyzed and compared these scoring models. Methods The study selected consecutive patients who presented with RAAA in two large vascular centers (Medisch Centrum Alkmaar and St. Antonius Nieuwegein) between 2005 and 2015. Variables necessary to retrospectively evaluate the scoring systems were registered in the patients' medical files. The discriminatory power and calibration were assessed using the receiver operating characteristic curve and the Hosmer-Lemeshow χ2 test. Results The study included 347 consecutive patients with RAAA. There were 298 men (85.9%), and the mean ± standard deviation age was 72.6 ± 8.1 years. The receiver operating characteristic curves were developed for the DAS, Glasgow Aneurysm Score (GAS), Edinburgh Ruptured Aneurysm Score, Vancouver Scoring System (VSS), and Hardman Index. The area under the curve was better for the VSS (0.716; 95% confidence interval [CI], 0.647-0.786) than for the other scoring systems. Areas under the curve for the DAS (0.664; 95% CI, 0.592-0.736), Hardman Index (0.664; 95% CI, 0.592-0.736), Edinburgh Ruptured Aneurysm Score (0.621; 95% CI, 0.543-0.700), and GAS (0.591; 95% CI, 0.517-0.665) were slightly smaller, although only the difference between the VSS and GAS was statistically significant. Calibration showed a good fit for all models. Conclusions The performance of the tested models for the prediction of mortality in RAAA patients was comparable, with only a statistically significant difference between the VSS and the GAS in favor of the VSS. However, an almost perfect prediction is needed to withhold intervention, and no existing scoring system is capable of that.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2016.05.099</identifier><identifier>PMID: 27575812</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal - diagnosis ; Aortic Aneurysm, Abdominal - mortality ; Aortic Aneurysm, Abdominal - surgery ; Aortic Rupture - diagnosis ; Aortic Rupture - mortality ; Aortic Rupture - surgery ; Area Under Curve ; Chi-Square Distribution ; Decision Support Techniques ; Female ; Humans ; Male ; Medical Futility ; Middle Aged ; Netherlands ; Patient Selection ; Predictive Value of Tests ; Reproducibility of Results ; Retrospective Studies ; Risk Assessment ; Risk Factors ; ROC Curve ; Surgery ; Time Factors ; Treatment Outcome ; Unnecessary Procedures ; Vascular Surgical Procedures - adverse effects ; Vascular Surgical Procedures - mortality</subject><ispartof>Journal of vascular surgery, 2016-12, Vol.64 (6), p.1609-1616</ispartof><rights>Society for Vascular Surgery</rights><rights>2016 Society for Vascular Surgery</rights><rights>Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c521t-ef593bda5845841c18f98831ec275c538456fc27dc80265ccb6575a34e6964f53</citedby><cites>FETCH-LOGICAL-c521t-ef593bda5845841c18f98831ec275c538456fc27dc80265ccb6575a34e6964f53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jvs.2016.05.099$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27575812$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vos, Cornelis G., MD, PhD</creatorcontrib><creatorcontrib>de Vries, Jean-Paul P.M., MD, PhD</creatorcontrib><creatorcontrib>Werson, Debora A.B., MPA</creatorcontrib><creatorcontrib>van Dongen, Eric P.A., MD, PhD</creatorcontrib><creatorcontrib>Schreve, Michiel A., MD</creatorcontrib><creatorcontrib>Ünlü, Çağdaş, MD, PhD</creatorcontrib><title>Evaluation of five different aneurysm scoring systems to predict mortality in ruptured abdominal aortic aneurysm patients</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Abstract Background Ruptured abdominal aortic aneurysms (RAAAs) are associated with a high overall mortality (up to 25% to 35%) ≤30 days when offered surgical treatment. Risk prediction models can provide valuable information on surgical risks, guide clinical decision making, and help identify patients who should not be operated on to prevent futile surgery. Finally, they can be used to evaluate clinical outcome. Different aneurysm scores are available. New ones (with only four parameters) are being developed, such as the Dutch Aneurysm Score (DAS). This study analyzed and compared these scoring models. Methods The study selected consecutive patients who presented with RAAA in two large vascular centers (Medisch Centrum Alkmaar and St. Antonius Nieuwegein) between 2005 and 2015. Variables necessary to retrospectively evaluate the scoring systems were registered in the patients' medical files. The discriminatory power and calibration were assessed using the receiver operating characteristic curve and the Hosmer-Lemeshow χ2 test. Results The study included 347 consecutive patients with RAAA. There were 298 men (85.9%), and the mean ± standard deviation age was 72.6 ± 8.1 years. The receiver operating characteristic curves were developed for the DAS, Glasgow Aneurysm Score (GAS), Edinburgh Ruptured Aneurysm Score, Vancouver Scoring System (VSS), and Hardman Index. The area under the curve was better for the VSS (0.716; 95% confidence interval [CI], 0.647-0.786) than for the other scoring systems. Areas under the curve for the DAS (0.664; 95% CI, 0.592-0.736), Hardman Index (0.664; 95% CI, 0.592-0.736), Edinburgh Ruptured Aneurysm Score (0.621; 95% CI, 0.543-0.700), and GAS (0.591; 95% CI, 0.517-0.665) were slightly smaller, although only the difference between the VSS and GAS was statistically significant. Calibration showed a good fit for all models. Conclusions The performance of the tested models for the prediction of mortality in RAAA patients was comparable, with only a statistically significant difference between the VSS and the GAS in favor of the VSS. 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de Vries, Jean-Paul P.M., MD, PhD ; Werson, Debora A.B., MPA ; van Dongen, Eric P.A., MD, PhD ; Schreve, Michiel A., MD ; Ünlü, Çağdaş, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c521t-ef593bda5845841c18f98831ec275c538456fc27dc80265ccb6575a34e6964f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Aneurysm, Abdominal - diagnosis</topic><topic>Aortic Aneurysm, Abdominal - mortality</topic><topic>Aortic Aneurysm, Abdominal - surgery</topic><topic>Aortic Rupture - diagnosis</topic><topic>Aortic Rupture - mortality</topic><topic>Aortic Rupture - surgery</topic><topic>Area Under Curve</topic><topic>Chi-Square Distribution</topic><topic>Decision Support Techniques</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical Futility</topic><topic>Middle Aged</topic><topic>Netherlands</topic><topic>Patient Selection</topic><topic>Predictive Value of Tests</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>ROC Curve</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Unnecessary Procedures</topic><topic>Vascular Surgical Procedures - adverse effects</topic><topic>Vascular Surgical Procedures - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vos, Cornelis G., MD, PhD</creatorcontrib><creatorcontrib>de Vries, Jean-Paul P.M., MD, PhD</creatorcontrib><creatorcontrib>Werson, Debora A.B., MPA</creatorcontrib><creatorcontrib>van Dongen, Eric P.A., MD, PhD</creatorcontrib><creatorcontrib>Schreve, Michiel A., MD</creatorcontrib><creatorcontrib>Ünlü, Çağdaş, MD, PhD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vos, Cornelis G., MD, PhD</au><au>de Vries, Jean-Paul P.M., MD, PhD</au><au>Werson, Debora A.B., MPA</au><au>van Dongen, Eric P.A., MD, PhD</au><au>Schreve, Michiel A., MD</au><au>Ünlü, Çağdaş, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of five different aneurysm scoring systems to predict mortality in ruptured abdominal aortic aneurysm patients</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2016-12-01</date><risdate>2016</risdate><volume>64</volume><issue>6</issue><spage>1609</spage><epage>1616</epage><pages>1609-1616</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>Abstract Background Ruptured abdominal aortic aneurysms (RAAAs) are associated with a high overall mortality (up to 25% to 35%) ≤30 days when offered surgical treatment. Risk prediction models can provide valuable information on surgical risks, guide clinical decision making, and help identify patients who should not be operated on to prevent futile surgery. Finally, they can be used to evaluate clinical outcome. Different aneurysm scores are available. New ones (with only four parameters) are being developed, such as the Dutch Aneurysm Score (DAS). This study analyzed and compared these scoring models. Methods The study selected consecutive patients who presented with RAAA in two large vascular centers (Medisch Centrum Alkmaar and St. Antonius Nieuwegein) between 2005 and 2015. Variables necessary to retrospectively evaluate the scoring systems were registered in the patients' medical files. The discriminatory power and calibration were assessed using the receiver operating characteristic curve and the Hosmer-Lemeshow χ2 test. Results The study included 347 consecutive patients with RAAA. There were 298 men (85.9%), and the mean ± standard deviation age was 72.6 ± 8.1 years. The receiver operating characteristic curves were developed for the DAS, Glasgow Aneurysm Score (GAS), Edinburgh Ruptured Aneurysm Score, Vancouver Scoring System (VSS), and Hardman Index. The area under the curve was better for the VSS (0.716; 95% confidence interval [CI], 0.647-0.786) than for the other scoring systems. Areas under the curve for the DAS (0.664; 95% CI, 0.592-0.736), Hardman Index (0.664; 95% CI, 0.592-0.736), Edinburgh Ruptured Aneurysm Score (0.621; 95% CI, 0.543-0.700), and GAS (0.591; 95% CI, 0.517-0.665) were slightly smaller, although only the difference between the VSS and GAS was statistically significant. Calibration showed a good fit for all models. Conclusions The performance of the tested models for the prediction of mortality in RAAA patients was comparable, with only a statistically significant difference between the VSS and the GAS in favor of the VSS. However, an almost perfect prediction is needed to withhold intervention, and no existing scoring system is capable of that.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27575812</pmid><doi>10.1016/j.jvs.2016.05.099</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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subjects Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - diagnosis
Aortic Aneurysm, Abdominal - mortality
Aortic Aneurysm, Abdominal - surgery
Aortic Rupture - diagnosis
Aortic Rupture - mortality
Aortic Rupture - surgery
Area Under Curve
Chi-Square Distribution
Decision Support Techniques
Female
Humans
Male
Medical Futility
Middle Aged
Netherlands
Patient Selection
Predictive Value of Tests
Reproducibility of Results
Retrospective Studies
Risk Assessment
Risk Factors
ROC Curve
Surgery
Time Factors
Treatment Outcome
Unnecessary Procedures
Vascular Surgical Procedures - adverse effects
Vascular Surgical Procedures - mortality
title Evaluation of five different aneurysm scoring systems to predict mortality in ruptured abdominal aortic aneurysm patients
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