학술논문
Long-term risk prediction after major lower limb amputation: 1-year results of the PERCEIVE study.
Document Type
Academic Journal
Author
Gwilym BL; School of Medicine, Cardiff University, Cardiff, UK.; Gwent Vascular Institute, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK.; Pallmann P; Centre for Trials Research, Cardiff University, Cardiff, UK.; Waldron CA; Centre for Trials Research, Cardiff University, Cardiff, UK.; Thomas-Jones E; Centre for Trials Research, Cardiff University, Cardiff, UK.; Milosevic S; Centre for Trials Research, Cardiff University, Cardiff, UK.; Brookes-Howell L; Centre for Trials Research, Cardiff University, Cardiff, UK.; Harris D; Centre for Trials Research, Cardiff University, Cardiff, UK.; Massey I; Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK.; Burton J; Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK.; Stewart P; Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK.; Samuel K; Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK.; Jones S; C/O INVOLVE Health and Care Research Wales, Cardiff, UK.; Cox D; C/O INVOLVE Health and Care Research Wales, Cardiff, UK.; Clothier A; School of Medicine, Cardiff University, Cardiff, UK.; Prout H; Centre for Trials Research, Cardiff University, Cardiff, UK.; Edwards A; Division of Population Medicine, Cardiff University, Cardiff, UK.; Twine CP; Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.; Bosanquet DC; School of Medicine, Cardiff University, Cardiff, UK.
Source
Publisher: Oxford University Press Country of Publication: England NLM ID: 101722685 Publication Model: Print Cited Medium: Internet ISSN: 2474-9842 (Electronic) Linking ISSN: 24749842 NLM ISO Abbreviation: BJS Open Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Decision-making when considering major lower limb amputation is complex and requires individualized outcome estimation. It is unknown how accurate healthcare professionals or relevant outcome prediction tools are at predicting outcomes at 1-year after major lower limb amputation.
Methods: An international, multicentre prospective observational study evaluating healthcare professional accuracy in predicting outcomes 1 year after major lower limb amputation and evaluation of relevant outcome prediction tools identified in a systematic search of the literature was undertaken. Observed outcomes at 1 year were compared with: healthcare professionals' preoperative predictions of death (surgeons and anaesthetists), major lower limb amputation revision (surgeons) and ambulation (surgeons, specialist physiotherapists and vascular nurse practitioners); and probabilities calculated from relevant outcome prediction tools.
Results: A total of 537 patients and 2244 healthcare professional predictions of outcomes were included. Surgeons and anaesthetists had acceptable discrimination (C-statistic = 0.715), calibration and overall performance (Brier score = 0.200) when predicting 1-year death, but performed worse when predicting major lower limb amputation revision and ambulation (C-statistics = 0.627 and 0.662 respectively). Healthcare professionals overestimated the death and major lower limb amputation revision risks. Consultants outperformed trainees, especially when predicting ambulation. Allied healthcare professionals marginally outperformed surgeons in predicting ambulation. Two outcome prediction tools (C-statistics = 0.755 and 0.717, Brier scores = 0.158 and 0.178) outperformed healthcare professionals' discrimination, calibration and overall performance in predicting death. Two outcome prediction tools for ambulation (C-statistics = 0.688 and 0.667) marginally outperformed healthcare professionals.
Conclusion: There is uncertainty in predicting 1-year outcomes following major lower limb amputation. Different professional groups performed comparably in this study. Two outcome prediction tools for death and two for ambulation outperformed healthcare professionals and may support shared decision-making.
(© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)
Methods: An international, multicentre prospective observational study evaluating healthcare professional accuracy in predicting outcomes 1 year after major lower limb amputation and evaluation of relevant outcome prediction tools identified in a systematic search of the literature was undertaken. Observed outcomes at 1 year were compared with: healthcare professionals' preoperative predictions of death (surgeons and anaesthetists), major lower limb amputation revision (surgeons) and ambulation (surgeons, specialist physiotherapists and vascular nurse practitioners); and probabilities calculated from relevant outcome prediction tools.
Results: A total of 537 patients and 2244 healthcare professional predictions of outcomes were included. Surgeons and anaesthetists had acceptable discrimination (C-statistic = 0.715), calibration and overall performance (Brier score = 0.200) when predicting 1-year death, but performed worse when predicting major lower limb amputation revision and ambulation (C-statistics = 0.627 and 0.662 respectively). Healthcare professionals overestimated the death and major lower limb amputation revision risks. Consultants outperformed trainees, especially when predicting ambulation. Allied healthcare professionals marginally outperformed surgeons in predicting ambulation. Two outcome prediction tools (C-statistics = 0.755 and 0.717, Brier scores = 0.158 and 0.178) outperformed healthcare professionals' discrimination, calibration and overall performance in predicting death. Two outcome prediction tools for ambulation (C-statistics = 0.688 and 0.667) marginally outperformed healthcare professionals.
Conclusion: There is uncertainty in predicting 1-year outcomes following major lower limb amputation. Different professional groups performed comparably in this study. Two outcome prediction tools for death and two for ambulation outperformed healthcare professionals and may support shared decision-making.
(© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)