Imperial College London


Faculty of MedicineDepartment of Surgery & Cancer

Visiting Professor



+44 (0)20 3311 7312j.powell




4E05Charing Cross HospitalCharing Cross Campus






BibTex format

author = {Sweeting, MJ and Ulug, P and Hultgren, R and Indrakusuma, R and Balm, R and Thompson, MM and Hinchliffe, RJ and Thompson, SG and Powell, JT and the, Ruptured Aneurysm Collaborators and including, IMPROVE and AJAX and ECAR, and STAR collaborators},
doi = {10.1002/bjs.10820},
journal = {British Journal of Surgery},
pages = {1135--1144},
title = {Value of risk scores in the decision to palliate patients withruptured abdominal aortic aneurysm},
url = {},
volume = {105},
year = {2018}

RIS format (EndNote, RefMan)

AB - Background:The aim of this study was to develop a 48h mortality risk score, which included morphology data, for patients with ruptured abdominal aortic aneurysm presenting to an emergency department, and to assess its predictive accuracy and clinical effectiveness in triaging patients to immediate aneurysm repair, transfer or palliative care.Methods:Data from patients in the IMPROVE (Immediate Management of the Patient With Ruptured Aneurysm: Open Versus Endovascular Repair) randomized trial were used to develop the risk score. Variables considered included age, sex, haemodynamic markers and aortic morphology. Backwards selection was used to identify relevant predictors. Predictive performance was assessed using calibration plots and the Cstatistic. Validation of the newly developed and other previously published scores was conducted in four external populations. The net benefit of treating patients based on a risk threshold compared with treating none was quantified.Results:Data from 536 patients in the IMPROVE trial were included. The final variables retained were age, sex, haemoglobin level, serum creatinine level, systolic BP, aortic neck length and angle, and acute myocardial ischaemia. The discrimination of the score for 48h mortality in the IMPROVE data was reasonable (Cstatistic 0·710, 95 per cent c.i. 0·659 to 0·760), but varied in external populations (from 0·652 to 0·761). The new score outperformed other published risk scores in some, but not all, populations. An 8 (95 per cent c.i. 5 to 11) per cent improvement in the Cstatistic was estimated compared with using age alone.Conclusion:The assessed risk scores did not have sufficient accuracy to enable potentially lifesaving decisions to be made regarding intervention. Focus should therefore shift to offering repair to more patients and reducing nonintervention rates, while respecting the wishes of the patient and family.
AU - Sweeting,MJ
AU - Ulug,P
AU - Hultgren,R
AU - Indrakusuma,R
AU - Balm,R
AU - Thompson,MM
AU - Hinchliffe,RJ
AU - Thompson,SG
AU - Powell,JT
AU - the,Ruptured Aneurysm Collaborators
AU - including,IMPROVE
AU - ECAR,and STAR collaborators
DO - 10.1002/bjs.10820
EP - 1144
PY - 2018///
SN - 1365-2168
SP - 1135
TI - Value of risk scores in the decision to palliate patients withruptured abdominal aortic aneurysm
T2 - British Journal of Surgery
UR -
UR -
VL - 105
ER -