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 ORIGINAL ARTICLE
Year : 2012  |  Volume : 60  |  Issue : 6  |  Page : 608--612

Preoperative APACHE II and GCS scores as predictors of outcomes in patients with malignant MCA infarction after decompressive hemicraniectomy


1 Department of Neurology, Tri Service General Hospital, Taipei, Taiwan, China
2 Department of Neurology, Tri Service General Hospital; Institute of Aerospace and Undersea Medicine, School of Medicine, Taipei, Taiwan, China
3 Department of Neurological Surgery, Tri Service General Hospital, Taipei, Taiwan, China
4 Department of Neurological Surgery, Tri Service General Hospital; Department of Biochemistry, National Defense Medical Center, Taipei, Taiwan, China

Correspondence Address:
Dueng-Yuan Hueng
Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.105195

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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.






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Online since 20th March '04
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