Publication

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

Journal Paper/Review - May 14, 2019

Units
PubMed
Doi

Citation
Maldaner N, Sosnova M, Sarnthein J, Bozinov O, Regli L, Stienen M. Predicting Functional Impairment in patients with chronic subdural hematoma treated with burr hole Trepanation-The FIT-score. Clin Neurol Neurosurg 2019; 182:142-147.
Type
Journal Paper/Review (English)
Journal
Clin Neurol Neurosurg 2019; 182
Publication Date
May 14, 2019
Issn Electronic
1872-6968
Pages
142-147
Brief description/objective

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.