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2 results

  • 11.3 - Principles of Outcome Prediction, Prognostic Indicators and Treatment Intensity Scales and Limitations of Scoring Systems in Predicting Individual Patient Outcome

  • from Section 11 - Professionalism, Patient Safety, Governance and Health Systems Management
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 746-748

  • Summary

    Key Learning Points

    1. 1. Precise estimates of post-operative mortality and morbidity are difficult to obtain and both are recognised to vary greatly, depending on a patient’s pre-operative functional status, the type and urgency of surgery and whether or not post-operative complications occur.

    2. 2. Risk scores apply a weighting to each factor, usually representing a component value for the score, with the resultant score corresponding with predicted risk.

    3. 3. Prognostic indicators may include population-based risk scores, individualised risk prediction models, objective functional capacity assessment and biomarkers.

    4. 4. Model discrimination describes how well a model discriminates between high- and low-risk patients, and is measured using a receiver operator characteristic curve (ROC) to calculate the area under the curve (AUC).

    5. 5. Technically, risk assessment tools are only valid for the specific patient population for whom the tool has been developed and on whom it has been tested.

  • 6 - Surgical management of symptomatic carotid disease: carotid endarterectomy and extracranial-intracranial bypass

  • from Background
  • Edited by Jonathan Gillard, University of Cambridge, Martin Graves, University of Cambridge, Thomas Hatsukami, University of Washington, Chun Yuan, University of Washington
  • Book:
    Carotid Disease
    Published online:
    03 December 2009
    Print publication:
    07 December 2006, pp 72-85

  • Summary

    This chapter reviews the major clinical trials on carotid endarterectomy and carotid angioplasty, and summarizes the technique used by the authors for carotid endarterectomy. The evolution of carotid endarterectomy, carotid angioplasty, and stenting and extracranial-intracranial (EC-IC) has been predicated on the results of clinical trials. The EC-IC bypass trial introduced the concept of multicenter prospective randomized trials to the neurosurgical community. The ongoing carotid revascularization endarterectomy versus stent trial (CREST) is prospectively randomizing patients with symptomatic carotid stenosis to either carotid endarterectomy or carotid angioplasty, and stenting with distal embolic protection (DEP), regardless of perioperative risk stratification. Assessing perioperative risk is essential in the evaluation of patients in whom carotid endarterectomy, carotid angioplasty and stenting or EC-IC bypass is being considered. Patients with symptomatic carotid occlusions may benefit from EC-IC revascularization provided they suffer from diminished cerebrovascular reserve.