O-069 - UK VALIDATION OF THE HARBORVIEW MEDICAL CENTER SCORE FOR AORTIC ANEURYSM RUPTURE MORTALITY.

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Budge J. (St George's Hospital ~ London ~ United Kingdom) , Rees O. (St George's Hospital ~ London ~ United Kingdom) , Azhar B. (St George's Hospital ~ London ~ United Kingdom) , Wafi A. (St George's Hospital ~ London ~ United Kingdom) , Selway W. (St George's Hospital ~ London ~ United Kingdom) , Loftus I. (St George's Hospital ~ London ~ United Kingdom) , Holt P. (St George's Hospital ~ London ~ United Kingdom)
Introduction:
Ruptured Aortic Aneurysms are a life-threatening condition with significant mortality. Several mortality risk scores have been presented, but many are ineffective at predicting futility or require intraoperative variables and thus not useful in pre-operative clinical decision making. The Harborview Medical Center (HMC) score comprises four equally weighted pre-operative scoring domains (Age > 76, Creatinine > 177umol/L, pH <7.2 and Systolic BP below 70) and has been validated in a US population. In this study, we aim to validate the HMC score in a UK population.
Methods:
All ruptured aortic aneurysm cases presenting to a single London teaching hospital over a 5-year period between 2015 to 2019 were identified using prospectively held databases. Data was retrospectively collected by screening electronic and paper notes. Where patients were transferred from another hospital data was sought from this site. Data were collected on baseline demographics, decision for operative or palliative management, 30-day mortality, and HMC score domains (Age at presentation, pH, lowest systolic blood pressure and creatinine).
Results:
A total of 214 patients were identified with a median age of 79, 75.7% were male, and an overall mortality rate of 57%. 91 (42.5%) were palliated, 65 (30.4%) had EVAR, 21 (9.8%) had TEVAR, 12 (5.6%) underwent complex aortic repair and 25 (11.7%) had redo repair. There was an overall mortality rate of 29.2% in those who had EVAR, 9.5% for TEVAR, 16.7% for complex aortic repair, 32% for redo cases, and 100% for palliated cases. Mortality by HMC score was 27.9% for score 0, 63.6% for score 1, 75.5% for score 2, 100% for score 3 and 100% for score 4. The total number of patients in score groups 0-4 was 61, 107, 37, 8, and 1 respectively. See table 1 for comparison between the HMC original validation and our study. There was missing pH data in 7.5% of patients, missing SBP data in 1.9%, missing Creatinine data in 3.3%, and no missing age data.
Conclusion:
We have shown that the 30-day mortality is related to HMC score in a UK population. However, we have seen a difference in outcome in patients scoring 1 in our population when compared to the HMC cohort. This may be due to missing data and subsequent depression of scores or due to differences in geographical catchment or local practice. Although a promising tool the HMC score requires wider prospective testing in the UK before adoption.
ATTACHMENTS: