Predicting the Outcome of Limb Revascularization in Patients With Lower-extremity Arterial Trauma: Development and External Validation of a Supervised Machine-learning Algorithm to Support Surgical Decisions.

Date

2020-10-01

Author

Perkins, Zane B.
Yet, Barbaros
Sharrock, Anna
Rickard, Rory
Marsh, William
Rasmussen, Todd E.
Tai, Nigel R M

Metadata

Show full item record

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Item Usage Stats

116
views

0
downloads

Objectives: Estimating the likely success of limb revascularization in patients with lower-extremity arterial trauma is central to decisions between attempting limb salvage and amputation. However, the projected outcome is often unclear at the time these decisions need to be made, making them difficult and threatening sound judgement. The objective of this study was to develop and validate a prediction model that can quantify an individual patient's risk of failed revascularization. Methods: A BN prognostic model was developed using domain knowledge and data from the US joint trauma system. Performance (discrimination, calibration, and accuracy) was tested using ten-fold cross validation and externally validated on data from the UK Joint Theatre Trauma Registry. BN performance was compared to the mangled extremity severity score. Results: Rates of amputation performed because of nonviable limb tissue were 12.2% and 19.6% in the US joint trauma system (n = 508) and UK Joint Theatre Trauma Registry (n = 51) populations respectively. A 10-predictor BN accurately predicted failed revascularization: area under the receiver operating characteristic curve (AUROC) 0.95, calibration slope 1.96, Brier score (BS) 0.05, and Brier skill score 0.50. The model maintained excellent performance in an external validation population: AUROC 0.97, calibration slope 1.72, Brier score 0.08, Brier skill score 0.58, and had significantly better performance than mangled extremity severity score at predicting the need for amputation [AUROC 0.95 (0.92–0.98) vs 0.74 (0.67–0.80); P < 0.0001]. Conclusions: A BN (https://www.traumamodels.com) can accurately predict the outcome of limb revascularization at the time of initial wound evaluation. This information may complement clinical judgement, support rational and shared treatment decisions, and establish sensible treatment expectations.

Subject Keywords

Surgery

URI

https://hdl.handle.net/11511/56818

Journal

Annals of surgery

DOI

https://doi.org/10.1097/sla.0000000000004132

Collections

Graduate School of Informatics, Article

Suggestions

OpenMETU
Core

Meta-analysis of prognostic factors for amputation following surgical repair of lower extremity vascular trauma Perkins, Z. B.; Yet, Barbaros; Glasgow, S.; Cole, E.; Marsh, W.; Brohi, K.; Rasmussen, T. E.; Tai, N. R. M. (Wiley, 2015-04-01) Background: Lower extremity vascular trauma (LEVT) is a major cause of amputation. A clear understanding of prognostic factors for amputation is important to inform surgical decision-making, patient counselling and risk stratification. The aim was to develop an understanding of prognostic factors for amputation following surgical repair of LEVT.
Prevention of postoperative late kyphosis in Pott's disease by anterior decompression and intervertebral grafting Korkusuz, Feza; Islam, C; Korkusuz, Z (Springer Science and Business Media LLC, 1997-06-01) A total of 185 patients with Pott's disease were operated on between 1973 and 1992. Anterior decompression by preserving the pleura (extrapleural approach) was the preferred method in the thoracic spine. In the lumbar spine the approach was retroperitoneal, and interbody fusion was performed in both for the thoracic and the Lumbar regions. Anterior decompression and intervertebral grafting comprised the treatment. In five patients, internal fixation accompanied anterior decompression and intervertebral graf...
Prognostic Factors for Amputation Following Surgical Repair of Lower Extremity Vascular Trauma: A Systematic Review and Meta-Analysis of Observational Studies Perkins, Zane B.; Yet, Barbaros; Glasgow, Simon; Marsh, William; Brohi, Karim; Rasmussen, Todd E.; Tai, Nigel R. (2014-06-01) Background: Lower extremity vascular trauma (LEVT) is a major cause of amputation. A clear understanding of prognostic factors for amputation is important to inform surgical decision-making, patient counselling and risk stratification. The aim was to develop an understanding of prognostic factors for amputation following surgical repair of LEVT. Methods: A systematic review was conducted to identify potential prognostic factors. Bayesian meta-analysis was used to calculate an absolute (pooled proportion) a...
THE RISK-FACTORS IN CENTRAL VENOUS CATHETER-RELATED THROMBOSIS KOKSOY, C; KUZU, A; ERDEN, I; Akkaya, Ayşen (Wiley, 1995-11-01) Catheter-related venous thrombosis is one of the most important complications of central venous catheters. The aim of this prospective study was to assess the risk factors that may be important in the development of catheter-related thrombosis. Multiple lumen (n = 20) and single lumen (n = 24) polyurethane catheters were inserted to the subclavian vein by the infraclavicular approach in 44 consecutive patients. All variables that may be significant for the development of thrombosis related to the patient, t...
Functional evaluation of intraarticular severely comminuted fractures of the calcaneus with gait analysis BOZKURT, Murat; Kentel, B. Behzat; Yavuzer, Gunes; Öçgüder, Ali; Heycan, Cengiz; Tönük, Ergin (Elsevier BV, 2004-11-01) Twenty-one patients (23 feet) treated nonsurgically for severely comminuted intraarticular fractures of the calcaneus were evaluated prospectively with a clinical scoring scale and computerized gait analysis. All patients had Sanders type III and type IV fractures. The treatment protocol consisted of no closed reduction, immobilization in removable splint, physiotherapy after edema subsided, and weightbearing after 8 weeks. All patients had a minimum follow-up of 2 years (mean, 38 months). Clinical results ...

Citation Formats

Z. B. Perkins et al., “Predicting the Outcome of Limb Revascularization in Patients With Lower-extremity Arterial Trauma: Development and External Validation of a Supervised Machine-learning Algorithm to Support Surgical Decisions.,” Annals of surgery, pp. 564–572, 2020, Accessed: 00, 2020. [Online]. Available: https://hdl.handle.net/11511/56818.