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Master Thesis

Aide à la prise de décision : les déterminants éthiques conduisant à la décision d’amputation ou non dans une population âgée présentant une artérite oblitérante des membres inférieurs à un stade sévère

Abstract : Background. Advanced stages of critical limb ischemia (CLI) in the elderly may lead to a difficult decision of amputation. The choice lies between a definitive surgery, following by painful dressings, an important psychological trauma and an uncertain future, or a palliative care. Among patients aged 70 or over CLI occurs at a prevalence of 15 to 20%, and in 2% of cases leads to amputation. Aim. We have developed a decision-making support questionnaire to help physicians and their teams make the most ethical decision in this particular context. Method. A retrospective study of data for 2006 in 3 different hospitals has enabled us to determine the statistical characteristics of our grid. Results. We have found out that with a 87,5% sensibility, a 75% specificity, a 70% positive predictive value and especially a 90% negative predictive value, our questionnaire is useful to reach the non-amputation decision. Objective medical criteria were those most often used in the decision making process for the 20 patients of our study. Conclusion. Our questionnaire is statistically helpful to make the most ethical decision to amputate or not elderly patients in advanced stages of CLI, but it should not be considered as a perfect diagnostic and decision tool. To confirm our results we must carry out a prospective survey of consecutive cases.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01131555
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Submitted on : Friday, March 13, 2015 - 6:22:12 PM
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  • HAL Id : dumas-01131555, version 1

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Vincent Poirier. Aide à la prise de décision : les déterminants éthiques conduisant à la décision d’amputation ou non dans une population âgée présentant une artérite oblitérante des membres inférieurs à un stade sévère. Médecine humaine et pathologie. 2014. ⟨dumas-01131555⟩

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