title: The Hardman index in patients operated on for ruptured abdominal aortic aneurysm: A systematic review.
abstract: BACKGROUND
  The aims of the present study were to (1) analyze preoperative predictors for outcome suggested by Hardman and surgical mortality after open repair and endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA), and (2) further evaluate the Hardman index in a systematic review.
  
  
  METHODS
  Patients operated on for rAAA during a 5-year period between 2000 and 2004 were scored according to Hardman-1 point for either age >76 years, loss of consciousness after presentation, hemoglobin <90 g/L, serum creatinine >190 micromol/L or electrocardiographic (ECG) signs of ischemia-with blinded evaluation of ECGs by a specialist in clinical physiology. The results were included in a systematic review of studies evaluating the Hardman index.
  
  
  RESULTS
  In-hospital mortality after operation was 41% (67/162). There was no difference in in-hospital mortality between open repair (n = 106) and EVAR (n = 56), whereas the Hardman index was associated with operative mortality in our institution and in the systematic review of 970 patients (P < .001). Mortality rate in patients with Hardman index > or =3 was 77% in the pooled analysis. A full data set of all five scoring variables was obtained in 94 (58%) of 162 patients in our study, and potential underscoring was thus possible in 68 patients. Of the available ECGs, 12 (8.7%) of 138 were judged nondiagnostic. Five studies did not state their missing data on ECG and hemoglobin and serum creatinine concentrations, nor did they specify the criteria for ECG ischemia.
  
  
  CONCLUSIONS
  A strong correlation between the Hardman index and mortality was found. A Hardman index > or =3 cannot be used as an absolute limit for denial of surgery. The utility of the Hardman index seems to be impeded by variability in scoring resulting from missing or nondiagnostic data.
authors.affiliation: Department of Vascular Diseases, Malmö University Hospital, Malmö, Sweden. stefan.acosta@telia.com
authors.forename: Stefan
authors.initials: S
authors.lastname: Acosta
authors.forename: Mats
authors.initials: M
authors.lastname: Ogren
authors.forename: David
authors.initials: D
authors.lastname: Bergqvist
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindblad
authors.forename: Magnus
authors.initials: M
authors.lastname: Dencker
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Zdanowski
mesh_terms: D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D011379:Prognosis; D012422:Rupture, Spontaneous; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D014057:Tomography, X-Ray Computed