title: Development and External Validation of a Model Predicting Death After Surgery in Patients With a Ruptured Abdominal Aortic Aneurysm: The Dutch Aneurysm Score.
abstract: OBJECTIVE
  The decision whether or not to proceed with surgical intervention of a patient with a ruptured abdominal aortic aneurysm (rAAA) is very difficult in daily practice. The primary objective of the present study was to develop and to externally validate a new prediction model: the Dutch Aneurysm Score (DAS).
  
  
  METHODS
  With a prospective cohort of 10 hospitals (n = 508) the DAS was developed using a multivariate logistic regression model. Two retrospective cohorts with rAAA patients from two hospitals (n = 373) were used for external validation. The primary outcome was the combined 30 day and in-hospital death rate. Discrimination (AUC), calibration plots, and the ability to identify high risk patients were compared with the more commonly used Glasgow Aneurysm Score (GAS).
  
  
  RESULTS
  After multivariate logistic regression, four pre-operative variables were identified: age, lowest in hospital systolic blood pressure, cardiopulmonary resuscitation, and haemoglobin level. The area under the receiver operating curve (AUC) for the DAS was 0.77 (95% CI 0.72-0.82) compared with the GAS with an AUC of 0.72 (95% CI 0.67-0.77). The DAS showed a death rate in patients with a predicted death rate ≥80% of 83%.
  
  
  CONCLUSIONS
  The present study shows that the DAS has a higher discriminative performance (AUC) compared with the GAS. All clinical variables used for the DAS are easy to obtain. Identification of low risk patients with the DAS can potentially reduce turndown rates. The DAS can reliably be used by clinicians to make a more informed decision in dialogue with the patient and their family whether or not to proceed with surgical intervention.
authors.affiliation: Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: G C I
authors.initials: GC
authors.lastname: von Meijenfeldt
authors.affiliation: Department of Surgery (Division of Vascular Surgery), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: S C
authors.initials: SC
authors.lastname: van Beek
authors.affiliation: Department of Angiology and Vascular Surgery, Hospital de Santa Marta, CHLC, Lisbon, Portugal; Department of Surgery (Division of Vascular Surgery), Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Bastos Gonçalves
authors.affiliation: Department of Surgery (Division of Vascular Surgery), Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: H J M
authors.initials: HJ
authors.lastname: Verhagen
authors.affiliation: Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: Zeebregts
authors.affiliation: Department of Surgery (Division of Vascular Surgery), Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Vahl
authors.affiliation: Department of Surgery (Division of Vascular Surgery), VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Wisselink
authors.affiliation: Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: m.j.vd.laan@umcg.nl.
authors.forename: M J
authors.initials: MJ
authors.lastname: van der Laan
authors.affiliation: Department of Surgery (Division of Vascular Surgery), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Balm
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D016887:Cardiopulmonary Resuscitation / Q000401:mortality; D003661:Decision Support Techniques; D005260:Female; D015600:Glasgow Coma Scale; D006454:Hemoglobins / Q000378:metabolism; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality*
chemical_list: D015415:Biomarkers; D006454:Hemoglobins
keywords: Abdominal; Aortic aneurysm; Aortic rupture; Mortality