Predictors of outcome after abdominal aortic aneurysm rupture: Edinburgh Ruptured Aneurysm Score.

BACKGROUND

Many surgeons adopt a selective policy of intervention for a ruptured abdominal aortic aneurysm (AAA). This study aimed to develop an objective method of identifying patients suitable for attempted repair.

METHODS

Consecutive patients selected for attempted repair of ruptured AAA over a 31-month period (January 2000 to July 2002) were entered into an observational study. Altogether, 53 preoperative physiological and biochemical variables were recorded and related to operative outcome.

RESULTS

A total of 105 patients underwent attempted repair of a ruptured AAA. There were 39 (37%) deaths in hospital or within 30 days of operation. On univariate analysis, hemoglobin <9 g/dl (p = 0.038), blood pressure <90 mmHg (p = 0.036), and Glasgow Coma Scale <15 (p = 0.016) were found to be risk factors that predicted death. Of 70 patients with no or one risk factor, 20 (29%) died. Of 30 patients with two factors, 15 (50%) died, and of the five patients with all three factors, four (80%) died. There was a significant association between mortality and cumulative risk factors (p = 0.003).

CONCLUSION

These three risk factors are easily assessed in the emergency setting and might form the basis of a scoring system to inform the outcome of ruptured AAA.