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Derivation and validation of a clinical scoring system to predict the need for an intra-aortic balloon pump in patients undergoing adult cardiac surgery

^a Emergency Medicine Research Group, Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
^b Blackpool Victoria Hospital, Blackpool, UK
^c North Staffordshire Infirmary, Stoke on Trent, UK

^* Corresponding author. Tel.: +44-780-154-8122; fax: +44-161-276-8538
joeldunning{at}doctors.org.uk

The spectrum of patients receiving cardiac surgery are increasing in age and severity of illness. With the reduction of complications caused by the placement of an intra-aortic balloon pump (IABP) there is increasing interest in the placement of an IABP prophylactically. We sought to derive a scoring system to guide the placement of IABPs. A total of 3927 patients from the Blackpool Victoria Open Heart Registry were used to derive a range of clinical decision scores using a range of established and novel statistical techniques. This database included 127 patients who received an IABP. The derived scores and rules were then validated on the North Staffordshire Open Heart Registry, containing 3070 patients, and 161 patients who received an IABP. We derived and validated a clinical score that has a sensitivity of 50% and a specificity of 96.5% in the prediction of those patients requiring an IABP. This was robust in the validation dataset and outperformed the Parsonnet score in this context. Our validated clinical scoring system will be useful both to guide individual clinical decision making and to compare variation of IABP usage among institutions.

Key Words: Intra-aortic balloon pumping; Clinical protocol; Thoracic surgery