Long-term risk prediction after major lower limb amputation: 1-year results of the PERCEIVE study
Brenig Llwyd Gwilym, Philip Pallmann, Cherry-Ann Waldron, Emma Thomas‐Jones, Sarah Milosevic, Lucy Brookes‐Howell, Debbie Harris, Ian Massey, Jo Burton, Phillippa Stewart, Katie Samuel, Siân Jones, David Cox, Annie Clothier, Hayley Prout, Adrian Edwards, Christopher P. Twine, David C. Bosanquet, Aminder Singh, Athanasios Saratzis, Brenig Llwyd Gwilym, David C. Bosanquet, George Dovell, Graeme K. Ambler, Joseph Shalhoub, Louise Hitchman, Matthew Machin, Nikesh Dattani, Panagiota Birmpili, Rachael O. Forsythe, Robert Blair, Ruth Benson, Ryan Preece, Sandip Nandhra, Sarah Onida, Amy Campbell, Anna Celnik, Bryce Renwick, Moore Jn, Karen A. Duncan, Martin Gannon, Mary Duguid, Patrice Forget, Dhafer Kamal, Mahmoud Tolba, Martin Maresch, Mohamed Abdulhameed Hatem, Mohamed Kabis, Ahmed Shalan, Hannah Travers, Maciej Juszczak, Mohammed Elsabbagh, Nikesh Dattani, António Pereira-Neves, João Rocha‐Neves, José Teixeira, Eric Lim, Khaleel Hamdulay, Oliver Lyons, Ashraf Azer, Chris Francis, Khalid Elsayed, Ragai Makar, Shady Zaki, Tamer Ghatwary-Tantawy, Devender Mittapalli, Hashem Barakat, Jessica Taylor, Ross Melvin, Samantha Veal, A Pachı̀, Antonia Skotsimara, Chrisostomos Maltezos, Christiana Anastasiadou, Efstratia Baili, George Kastrisios, Konstantinos Maltezos, Athanasios Saratzis, Badri Vijaynagar, Elizabeth Montague-Johnstone, Euan Bright, Kirsty Stewart, Rahul Velineni, Simon Lau, W. King, Christina Papadimitriou, Christos D. Karkos, Maria Mitka, Emily Chan, George Smith, A Vijay, Anita Eseenam Agbeko, Joachim Amoako, Joseph Shalhoub, Matthew Machin, A Antoniou, Konstantinos Roditis, Nikolaos Bessias, Paraskevi Tsiantoula, Theofanis Papas
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.