title: Ruptured abdominal aortic aneurysm. Is it possible to predict outcome?
abstract: OBJECTIVE
  Mortality after ruptured abdominal aortic aneurysm (rAAA) remains high. Hardman et al. suggested that the following factors predict perioperative death: age >76 years, loss of consciousness, ECG confirmed ischemia, creatinine over 180 micromol/l and hemoglobin below 9 g/dl. A score of 3 or more had 100% mortality. A retrospective study was performed to validate this and determine if modification is required.
  
  
  METHODS
  Retrospective analysis of the 5 Hardman Index factors along with preoperative systolic blood pressure at presentation, after resuscitation and during surgery was performed.
  
  
  RESULTS
  A total of 137 cases were reviewed with overall mortality of 56.2%. Of Hardman's criteria: age, ECG ischemic changes, creatinine and hemoglobin levels were significant in predicting outcome (p=0.0007, 0.0152, 0.0001 and 0.0213, respectively). Loss of consciousness was not significant (p=0.9054). Hardman scores of 0, 1, 2, 3, and 4 scored mortality percentages of 40.4%, 46.4%, 76.7%, 91.7% and 100%, respectively. Systolic blood pressure was significantly predictive at 100 mmHg and 120 mmHg on presentation (p=0.0008 and 0.0017, respectively) and 100 mmHg and 120 mmHg after resuscitation (p=0.0001 and 0.0510, respectively). A modified score replaced loss of consciousness with systolic blood pressure below 100 mmHg with scores of 0, 1, 2, 3, and 4 had mortality of 22.2%, 46.8%, 66.7%, 83.9% and 100%, respectively.
  
  
  CONCLUSIONS
  Our data supports the effectiveness of the Hardman Index in predicting successful surgery. However loss of consciousness was not a significant predictor. We proposed review of predictive indices, but resources should be channelled into screening to prevent rAAA.
authors.affiliation: Vascular Surgery Unit, Wythenshawe Hospital, Manchester, UK.
authors.forename: R
authors.initials: R
authors.lastname: Calderwood
authors.forename: T
authors.initials: T
authors.lastname: Halka
authors.forename: P
authors.initials: P
authors.lastname: Haji-Michael
authors.forename: M
authors.initials: M
authors.lastname: Welch
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D006801:Humans; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome