Artikel
A new scoring system for prediction of long-term functional outcome after surgery for chronic subdural hematoma – a prospective study
Neuer Score zur Prädiktion des langfristigen Outcomes nach chirurgischer Behandlung chronischer Subduralhämatome – eine prospektive Studie
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Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: A recent study showed a frequent elevation of brain natriuretic peptide (BNP) serum levels in patients with symptomatic chronic subdural hematoma (cSDH). In this study, the prediction of the long-term functional outcome was assessed, and a new predictive score developed.
Methods: We prospectively included patients with symptomatic cSDH that were surgically treated in our department between November 2016 and December 2019. BNP serum levels and clinical condition on admission were recorded. The patients were followed up at 5-6 months after surgery using a simplified modified Rankin Scale (mRS) questionnaire in a standardized telephone interview. An unfavorable outcome was defined by a mRS> 3. Based on predictors of the long-term functional outcome, a predictive score was computed, and its accuracy was tested using the area under the curve (AUC) of the receiver operating characteristic analysis.
Results: Altogether, 119 patients were analyzed (median age: 76 years, range: 44-94 years). BNP on admission was elevated in 77 patients (64.7%). Only 101 patients (84.8%) were available for the follow-up phone interview. In the multivariate analysis, unfavorable outcome at follow-up could be predicted using BNP serum levels (p=0.034), patient’s age (p=0.036), motor deficit (p=0.013) and Glasgow coma scale score on admission (p=0.008). The computed “Functional Long-term Outcome Predictive score” (FLOP-score) revealed an excellent discriminative capacity for unfavorable outcome at follow-up compared to other scores, with an AUC of 0.86 (0.77 – 0.95).
Conclusion: The FLOP-score is an easy-to-use tool providing crucial clinical information that may guide neurosurgeons in decision-making and help to anticipate persistent functional impairment prior to surgery. To validate our promising data, an external validation of the proposed score is mandatory.