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69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

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Validation of the enhanced detection of edema in malignant anterior circulation stroke (EDEMA) score for early patient selection needing decompressive hemicraniectomy

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  • Christoph Bettag - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Dorothee Mielke - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Vesna Malinova - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocV130

doi: 10.3205/18dgnc132, urn:nbn:de:0183-18dgnc1323

Published: June 18, 2018

© 2018 Bettag et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Up to 10% of patients with ischemic strokes develop a malignant edema. In patients with malignant cerebral infarction (MCI), early decompressive hemicraniectomy (DHC) can significantly reduce mortality. Early detection of patients developing MCI is still a challenge, since no reliable clinical or imaging criteria have been established yet. Recently a score was developed to predict potentially lethal edema in patients with MCI. The aim of this study was to perform an external validation of the EDEMA score in our patient population.

Methods: A retrospective analysis of patients with ischemic stroke of the anterior circulation between 2011 to 2017 was performed. Patients who underwent a DHC or no DHC were separated in two groups. For each patient the EDEMA score was calculated using the following independent predictors: basal cistern effacement (=3), glucose level at admission > 150 mg/dl (=2), no intravenous thrombolysis or thrombectomy (=1), midline shift (0- 3 mm =1, 4- 6 mm = 2, 7- 9 mm =4, >9 mm = 7) and no previous stroke (=1).

Results: A total of 180 patients with ischemic stroke were included in the study. The mean age was 67 years (25-96). In 90 patients DHC was performed. The mean EDEMA-score in the DHC-group was 6.7 (95%CI 6.19- 7.33) and 2.07 (95%CI 1.75- 2.40) in the non-DHC group. There was a significant correlation between the EDEMA-Score and DHC (OR = 55 95%CI 14.57-234.8; p < 0.0001). The cut-off value for malignant edema with the necessity of DHC was 7 (ROC analysis AUC 92% (95%CI 89-95%; p<0.0001). An EDEMA score ≥ 7 predicts malignant edema with a sensitivity of 96% (95%CI 87-99%), specificity of 69% (95%CI 60-76%), positive predictive value of 56% (95%CI 45-65%) and negative predictive value of 98% (95%CI 92-99%).

Conclusion: After applying the EDEMA score in our patient population we found a significant correlation between an EDEMA score ≥ 7 with the development of malignant edema needing DHC. Since the EDEMA score is based on parameters available at admission, the EDEMA score might be a useful tool for the early detection of patients who will need DHC. This has to be confirmed in a prospective study.