Assessing the benefits of hemicraniectomy: what is a favourable outcome?

Puetz, Volker; Campos, Cynthia Resende; Eliasziw, Michael; Hill, Michael D.; Demchuk, Andrew M.

doi:10.1016/s1474-4422(07)70160-6

Cited by 82 publications

(39 citation statements)

References 5 publications

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“…Looking at motor function, the benefit of surviving malignant MCA infarction after hemicraniectomy seems to be largely outweighed by the high incidence of moderately severe or severe disability in survivors. 25 However, the more important question is if the mRS is an adequate outcome measure in those patients. From the patients' perspective, neuropsychological deficits, aphasia, or depression may have an equally strong impact on quality of life as compared with motor function.…”

Section: Unanswered Questions and Future Directionsmentioning

confidence: 99%

Hemicraniectomy in Malignant Middle Cerebral Artery Infarction

Staykov

Gupta²

2011

Stroke

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Section: Unanswered Questions and Future Directionsmentioning

confidence: 99%

Hemicraniectomy in Malignant Middle Cerebral Artery Infarction

Staykov

Gupta²

2011

Stroke

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“…What outcome actually constitutes an "unacceptable" one after a life-saving procedure remains a subject of debate; 5,23,32 however, some consideration must always be given to an outcome that is most likely to be acceptable to the individual in whom the procedure is being performed. 10 This study has demonstrated that the predicted risk of unfavorable outcome at 6 months is strongly associated with the observed overall outcome at 18 months.…”

Section: Discussionmentioning

confidence: 99%

Validation of the CRASH model in the prediction of 18-month mortality and unfavorable outcome in severe traumatic brain injury requiring decompressive craniectomy

Honeybul

Ho²,

Lind³

et al. 2014

JNS

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Object The goal in this study was to assess the validity of the corticosteroid randomization after significant head injury (CRASH) collaborators prediction model in predicting mortality and unfavorable outcome at 18 months in patients with severe traumatic brain injury (TBI) requiring decompressive craniectomy. In addition, the authors aimed to assess whether this model was well calibrated in predicting outcome across a wide spectrum of severity of TBI requiring decompressive craniectomy. Methods This prospective observational cohort study included all patients who underwent a decompressive craniectomy following severe TBI at the two major trauma hospitals in Western Australia between 2004 and 2012 and for whom 18-month follow-up data were available. Clinical and radiological data on initial presentation were entered into the Web-based model and the predicted outcome was compared with the observed outcome. In validating the CRASH model, the authors used area under the receiver operating characteristic curve to assess the ability of the CRASH model to differentiate between favorable and unfavorable outcomes. Results The ability of the CRASH 6-month unfavorable prediction model to differentiate between unfavorable and favorable outcomes at 18 months after decompressive craniectomy was good (area under the receiver operating characteristic curve 0.85, 95% CI 0.80–0.90). However, the model's calibration was not perfect. The slope and the intercept of the calibration curve were 1.66 (SE 0.21) and −1.11 (SE 0.14), respectively, suggesting that the predicted risks of unfavorable outcomes were not sufficiently extreme or different across different risk strata and were systematically too high (or overly pessimistic), respectively. Conclusions The CRASH collaborators prediction model can be used as a surrogate index of injury severity to stratify patients according to injury severity. However, clinical decisions should not be based solely on the predicted risks derived from the model, because the number of patients in each predicted risk stratum was still relatively small and hence the results were relatively imprecise. Notwithstanding these limitations, the model may add to a clinician's ability to have better-informed conversations with colleagues and patients' relatives about prognosis.

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“…But we should question whether this is an acceptable division as it stands and whether the current use of it retains that acceptability. 12 In the pooled analysis of the 3 European stroke trials published in 2007, it was only possible to demonstrate a significant improvement in favorable outcome by recategorizing favorable as a mRS score of ≤4. 13 This would therefore include patients who were unable to walk unaided and unable to attend to their own bodily needs without assistance, but it could be argued that, given that these are relatively young people and the alternative would be not to survive at all, a patient may reasonably want to be given the chance to risk survival with an mRS score of 4 (immobile and dependent) in the hope that they will either achieve an mRS score of 3 or learn to accept a level of disability that they might previously have deemed unacceptable.…”

Section: Long-term Outcomementioning

confidence: 99%