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

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.

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.

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).

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.