The role of surgeon's intuition for acute type A aortic dissection in an era of evidence-based medicine : a prospective cohort study
2023 Journal of Thoracic Disease. All rights reserved..
Background: Intuition may play a role in clinical practice. This prospective cohort study aimed to explore whether surgeons' intuition is valid in predicting the operative mortality of acute type A aortic dissection (ATAAD).
Methods: After admission (before surgery), attending surgeons were asked to rate the mortality on a scale of 1 to 10, with 1 to 3 representing unlikely, 4-6 possible, and 7-10 very likely. The area under the curve (AUC) of receiver operating characteristic (ROC) analysis was performed to assess the accuracy of prediction models.
Results: A significantly higher Surgeon's Score [5.0 (2.0, 8.0) vs. 8.0 (7.0, 10.0)] was observed in the mortality group, compared to the survival group. The odds ratio (OR) for Surgeon's Score was 1.32 [95% confidence interval (CI): 1.09-1.66, P=0.009]. Least absolute shrinkage and selection operator (LASSO) regression picked the following variables as significant predictors for early mortality of ATAAD: Surgeon's Score, Penn classification, age, aortic regurgitation, coronary artery disease, chronic obstructive pulmonary disease, platelet count, and ejection fraction. The AUC for the German Registry for Acute Aortic Dissection Type A (GERAADA) score and Surgeon's Score were 0.740 (95% CI: 0.625-0.854), and 0.710 (95% CI: 0.586-0.833), respectively. The combined model of GERAADA score and Surgeon's Score yielded an AUC of up to 0.761 (95% CI: 0.638-0.884).
Conclusions: Intuition certainly has a place alongside evidence-based medicine. The duet of intuition and statistics-based scoring systems allows us to make more accurate predictions, potentially resulting in more rational clinical decisions.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:15 |
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| Enthalten in: |
Journal of thoracic disease - 15(2023), 10 vom: 31. Okt., Seite 5525-5533 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wu, Jinlin [VerfasserIn] |
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| Links: |
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| Themen: |
Aortic dissection |
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| Anmerkungen: |
Date Revised 12.02.2024 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.21037/jtd-23-630 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM364608595 |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a 2023 Journal of Thoracic Disease. All rights reserved. | ||
| 520 | |a Background: Intuition may play a role in clinical practice. This prospective cohort study aimed to explore whether surgeons' intuition is valid in predicting the operative mortality of acute type A aortic dissection (ATAAD) | ||
| 520 | |a Methods: After admission (before surgery), attending surgeons were asked to rate the mortality on a scale of 1 to 10, with 1 to 3 representing unlikely, 4-6 possible, and 7-10 very likely. The area under the curve (AUC) of receiver operating characteristic (ROC) analysis was performed to assess the accuracy of prediction models | ||
| 520 | |a Results: A significantly higher Surgeon's Score [5.0 (2.0, 8.0) vs. 8.0 (7.0, 10.0)] was observed in the mortality group, compared to the survival group. The odds ratio (OR) for Surgeon's Score was 1.32 [95% confidence interval (CI): 1.09-1.66, P=0.009]. Least absolute shrinkage and selection operator (LASSO) regression picked the following variables as significant predictors for early mortality of ATAAD: Surgeon's Score, Penn classification, age, aortic regurgitation, coronary artery disease, chronic obstructive pulmonary disease, platelet count, and ejection fraction. The AUC for the German Registry for Acute Aortic Dissection Type A (GERAADA) score and Surgeon's Score were 0.740 (95% CI: 0.625-0.854), and 0.710 (95% CI: 0.586-0.833), respectively. The combined model of GERAADA score and Surgeon's Score yielded an AUC of up to 0.761 (95% CI: 0.638-0.884) | ||
| 520 | |a Conclusions: Intuition certainly has a place alongside evidence-based medicine. The duet of intuition and statistics-based scoring systems allows us to make more accurate predictions, potentially resulting in more rational clinical decisions | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Intuition | |
| 650 | 4 | |a aortic dissection | |
| 650 | 4 | |a mortality | |
| 650 | 4 | |a prediction | |
| 650 | 4 | |a surgeon | |
| 700 | 1 | |a Chen, Zerui |e verfasserin |4 aut | |
| 700 | 1 | |a Du, Junzhe |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Julia Fayanne |e verfasserin |4 aut | |
| 700 | 1 | |a Sun, Tucheng |e verfasserin |4 aut | |
| 700 | 1 | |a Yu, Changjiang |e verfasserin |4 aut | |
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