Easterlin et al reported an index for predicting mortality in patients undergoing a major amputation. This index can help to identify a patient who may benefit from a more aggressive management. The authors are from the University of California San Diego and University of California Irvine.
Patient selection: major amputation (above the knee, below the knee, other lower extremity amputations)
Outcome: 30-day mortality (occurred in 8.1% of 9,244 patients)
Parameters:
(1) age in years
(2) steroid use
(3) functional status
(4) dialysis
(5) dyspnea
(6) history of congestive heart failure (CHF)
(7) history of COPD
(8) impaired sensorium
(9) preoperative sepsis
(10) history of previous cardiac surgery
Parameter |
Finding |
Points |
age in years |
< 60 years |
0 |
|
60 to 79 years |
1 |
|
>= 80 years |
2 |
steroid use |
no |
0 |
|
yes |
1 |
functional status |
non dependent |
0 |
|
dependent |
2 |
dialysis |
no |
0 |
|
yes |
2 |
dyspnea |
no |
0 |
|
yes |
1 |
history of CHF |
no |
0 |
|
yes |
1 |
history of COPD |
no |
0 |
|
yes |
1 |
impaired sensorium |
no |
0 |
|
yes |
1 |
preoperative sepsis |
no |
0 |
|
yes |
1 |
previous cardiac surgery |
no |
0 |
|
yes |
1 |
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maximum score: 13
• The higher the score the greater the mortality.
Score |
30-Day Mortality |
0 |
0.3% |
1 |
1% |
2 |
3% |
3 |
5% |
4 |
8% |
5 |
10% |
6 |
20% |
7 |
20% |
8 |
29% |
9 |
33% |
10 |
39% |
> 10 |
> 40% |
Performance:
• The area under the ROC curve was 0.74.
Specialty: Surgery, orthopedic, Surgery, general