OBJECTIVE: Decompressive hemicraniectomy is accepted as the most effective life-saving treatment for malignant middle cerebral artery (MCA) infarction. However, the outcome remains hard to predict. This study examined the efficacy of using the Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores before emergency craniectomy for predicting clinical outcome in malignant MCA infarction. MATERIALS AND METHODS: Seventy-nine consecutive patients with malignant MCA infarction treated from January 2006 to October 2010 were retrospectively analyzed. The GCS and APACHE II scores within the first 24 h of neurological deterioration or before decompressive hemicraniectomy, were used to predict short-term functional outcome rated by the modified Rankin Scale (mRS). The receiver operating characteristic (ROC) curve was obtained to determine the accuracy and best cut-off value for each scoring system. RESULTS: At 6 months, there was dramatic life-saving effect of surgery, with a significant reduction in mortality rate (from 71% to 19%, P < 0.001). After the ROC analysis, cut-off values of pre-operative GCS > 8 (P = 0.003) and APACHE II <13 (P = 0.006) were sufficiently sensitive and specific to predict favorable outcome (mRS 0-3). CONCLUSIONS: Pre-operative GCS and APACHE II scores are useful tools in predicting outcomes for patients with malignant MCA infarction who underwent decompressive hemicraniectomy.
OBJECTIVE: Decompressive hemicraniectomy is accepted as the most effective life-saving treatment for malignant middle cerebral artery (MCA) infarction. However, the outcome remains hard to predict. This study examined the efficacy of using the Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores before emergency craniectomy for predicting clinical outcome in malignant MCA infarction. MATERIALS AND METHODS: Seventy-nine consecutive patients with malignant MCA infarction treated from January 2006 to October 2010 were retrospectively analyzed. The GCS and APACHE II scores within the first 24 h of neurological deterioration or before decompressive hemicraniectomy, were used to predict short-term functional outcome rated by the modified Rankin Scale (mRS). The receiver operating characteristic (ROC) curve was obtained to determine the accuracy and best cut-off value for each scoring system. RESULTS: At 6 months, there was dramatic life-saving effect of surgery, with a significant reduction in mortality rate (from 71% to 19%, P < 0.001). After the ROC analysis, cut-off values of pre-operative GCS > 8 (P = 0.003) and APACHE II <13 (P = 0.006) were sufficiently sensitive and specific to predict favorable outcome (mRS 0-3). CONCLUSIONS: Pre-operative GCS and APACHE II scores are useful tools in predicting outcomes for patients with malignant MCA infarction who underwent decompressive hemicraniectomy.
Authors: Whitney S Livingston; Jessica M Gill; Martin R Cota; Anlys Olivera; Jessica L O'Keefe; Christiana Martin; Lawrence L Latour Journal: J Neurotrauma Date: 2016-08-30 Impact factor: 5.269
Authors: Bilal Kamal Alam; Ahmed S Bukhari; Salman Assad; Pir Muhammad Siddique; Haider Ghazanfar; Muhammad Junaid Niaz; Maryam Kundi; Saima Shah; Maimoona Siddiqui Journal: Cureus Date: 2017-01-26
Authors: Haifa M Algethamy; Afnan Samman; Saleh S Baeesa; Mohammed A Almekhlafi; Yousef A Al Said; Ahmed Hassan Journal: Neurosciences (Riyadh) Date: 2017-07 Impact factor: 0.906
Authors: Taco Goedemans; Dagmar Verbaan; Bert A Coert; Bertjan Kerklaan; René van den Berg; Jonathan M Coutinho; Tessa van Middelaar; Paul J Nederkoorn; W Peter Vandertop; Pepijn van den Munckhof Journal: Neurosurgery Date: 2020-03-01 Impact factor: 4.654