Analytic decision-making in patients with critical limb ischaemia.
Patients with critical limb ischaemia have a relative short life expectancy. However, if the limb can be preserved or amputation postponed for at least 1-2 years there can be justification for revascularisation if it is possible. Published Scandinavian data indicate that of those operated on about one-third are primarily amputated and two-third revascularised. At least one-third in the revascularisation group are subjected to secondary amputation within six months, and about 50% are alive with the limb intact. Hence, prediction of successful reconstruction should be amended to reduce costs and reduce burden to the patients. In order to achieve statistical models, which preoperatively could predict outcome with an acceptable diagnostic accuracy, national as well as international cooperation with standardisation of predictors and appropriate use of statistical models should be strived for. Prediction, based on a statistical model, is always associated with some uncertainty, and will never replace qualified clinical judgement.
Department of Vascular Surgery, Aker Hospital, Oslo, Norway.
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Rosén
D000671:Amputation, Surgical; D016638:Critical Illness; D003661:Decision Support Techniques; D006801:Humans; D007511:Ischemia / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D009664:Norway; D010043:Outcome and Process Assessment, Health Care; D014656:Vascular Surgical Procedures