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Predicting Functional Impairment in patients with chronic subdural hematoma treated with burr hole Trepanation - The FIT-score


Maldaner, Nicolai; Sosnova, Marketa; Sarnthein, Johannes; Bozinov, Oliver; Regli, Luca; Stienen, Martin N (2019). Predicting Functional Impairment in patients with chronic subdural hematoma treated with burr hole Trepanation - The FIT-score. Clinical Neurology and Neurosurgery, 182:142-147.

Abstract

Objective
It remains difficult to estimate prolonged functional impairment in patients with chronic subdural hematoma (cSDH) treated with burr hole trepanation. We aim to establish a score that reliably predicts postoperative functional impairment.
Patients and methods
Retrospectively analysis of a prospective institutional database. cSDH patients operated in 2013–2016 were identified. Clinical outcome was dichotomized into presence (modified-Rankin-Scale (mRS) ≥ 2) or absence of functional impairment (mRS 0–1) at discharge and last follow-up. A score was developed, based on the effect sizes of a set of outcome predictors. Its accuracy was tested using Area Under the Receiver-Operating Characteristic (AUROC) curve analysis. The 2017 cohort served for internal validation.
Results
A cohort of 253 patients (mean age 75 years, 75% male) was analyzed, of which 77 patients (30%) remained functionally impaired. In multivariate analysis, severe motor deficits at admission (OR 5.84, 95% CI 2.71–12.59, p < 0.001), age (≥85 years: 5.53, 2.14–14.32, p < 0.0001) and disorientation at admission (2.65, 11.39–5.05, p = 0.003) were associated with persistent functional impairment. Based on those variables, we created the “Functional Impairment after burr hole Trepanation” (FIT-score), which showed an AUROC of 0.77 (95% CI 0.70–0.83) for impairment at discharge and 0.76 (0.70–0.82) for impairment at follow-up. Internal validation confirmed the model with an AUROC of 0.79 (0.68–0.91) at discharge and 0.77 (0.64–91) at follow-up.
Conclusions
The FIT-score is likely to assist the physician when counseling patients and relatives pertaining to the need for postoperative rehabilitation and mid- to long-term supportive home care.

Abstract

Objective
It remains difficult to estimate prolonged functional impairment in patients with chronic subdural hematoma (cSDH) treated with burr hole trepanation. We aim to establish a score that reliably predicts postoperative functional impairment.
Patients and methods
Retrospectively analysis of a prospective institutional database. cSDH patients operated in 2013–2016 were identified. Clinical outcome was dichotomized into presence (modified-Rankin-Scale (mRS) ≥ 2) or absence of functional impairment (mRS 0–1) at discharge and last follow-up. A score was developed, based on the effect sizes of a set of outcome predictors. Its accuracy was tested using Area Under the Receiver-Operating Characteristic (AUROC) curve analysis. The 2017 cohort served for internal validation.
Results
A cohort of 253 patients (mean age 75 years, 75% male) was analyzed, of which 77 patients (30%) remained functionally impaired. In multivariate analysis, severe motor deficits at admission (OR 5.84, 95% CI 2.71–12.59, p < 0.001), age (≥85 years: 5.53, 2.14–14.32, p < 0.0001) and disorientation at admission (2.65, 11.39–5.05, p = 0.003) were associated with persistent functional impairment. Based on those variables, we created the “Functional Impairment after burr hole Trepanation” (FIT-score), which showed an AUROC of 0.77 (95% CI 0.70–0.83) for impairment at discharge and 0.76 (0.70–0.82) for impairment at follow-up. Internal validation confirmed the model with an AUROC of 0.79 (0.68–0.91) at discharge and 0.77 (0.64–91) at follow-up.
Conclusions
The FIT-score is likely to assist the physician when counseling patients and relatives pertaining to the need for postoperative rehabilitation and mid- to long-term supportive home care.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Surgery
Health Sciences > Neurology (clinical)
Uncontrolled Keywords:AUROC; Burr hole trepanation; Chronic subdural hematoma; Outcome; ROC; Score, Surgery, Clinical Neurology, General Medicine
Language:English
Date:1 July 2019
Deposited On:21 Aug 2019 07:45
Last Modified:29 Jul 2020 11:09
Publisher:Elsevier
ISSN:0303-8467
OA Status:Closed
Publisher DOI:https://doi.org/10.1016/j.clineuro.2019.05.012
PubMed ID:31125897

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