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The Hardman index in patients operated on for ruptured abdominal aortic aneurysm: A systematic review.

Acosta, Stefan LU ; Ogren, Mats; Bergqvist, David; Lindblad, Bengt LU ; Dencker, Magnus LU and Zdanowski, Zbigniew (2006) In Journal of Vascular Surgery 44(5). p.949-954
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 mu mol/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... (More)
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 mu mol/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 >= 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 ischermia. Conclusions: A strong correlation between the Hardman index and mortality was found. A Hardman index >= 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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Vascular Surgery
volume
44
issue
5
pages
949 - 954
publisher
Mosby
external identifiers
  • wos:000241714300009
  • scopus:33846232305
ISSN
1097-6809
DOI
10.1016/j.jvs.2006.07.041
language
English
LU publication?
yes
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7eb32d50-52ce-4008-8aef-3595c31a9fc6 (old id 163293)
alternative location
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=17098525&dopt=Abstract
date added to LUP
2007-07-09 13:24:31
date last changed
2019-10-29 03:41:34
@article{7eb32d50-52ce-4008-8aef-3595c31a9fc6,
  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 &gt; 76 years, loss of consciousness after presentation, hemoglobin &lt; 90 g/L, serum creatinine &gt; 190 mu mol/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 &lt;.001). Mortality rate in patients with Hardman index &gt;= 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 ischermia. Conclusions: A strong correlation between the Hardman index and mortality was found. A Hardman index &gt;= 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.},
  author       = {Acosta, Stefan and Ogren, Mats and Bergqvist, David and Lindblad, Bengt and Dencker, Magnus and Zdanowski, Zbigniew},
  issn         = {1097-6809},
  language     = {eng},
  number       = {5},
  pages        = {949--954},
  publisher    = {Mosby},
  series       = {Journal of Vascular Surgery},
  title        = {The Hardman index in patients operated on for ruptured abdominal aortic aneurysm: A systematic review.},
  url          = {http://dx.doi.org/10.1016/j.jvs.2006.07.041},
  volume       = {44},
  year         = {2006},
}