Development and validation of a prognostic computed tomography scoring model for functional outcomes in patients with...

Area of Science:

• Neurology
• Radiology
• Neurosurgery

Background:

• No established prognostic scoring system exists for large hemispheric infarction (LHI) patients undergoing decompressive craniectomy (DC) based on imaging.
• Existing prognostic tools lack specificity for LHI patients treated with DC.

Purpose of the Study:

• To develop and validate a novel computed tomography (CT) scoring model.
• To assess the 6-month risk of poor functional outcomes (modified-Rankin Scale [mRS] score of 4-6) in LHI patients receiving DC.

Main Methods:

• Retrospective cohort study at two tertiary stroke centers.
• Multivariable logistic regression used to develop a prediction model incorporating ASPECTS, longitudinal fissure cistern, Sylvian fissure cistern, and vascular territory.
• Validation through 1,000 bootstrap resamples and temporal validation.

Main Results:

• The scoring model demonstrated excellent discrimination (C-index=0.87 development, C-index=0.83 validation) and calibration.
• The model showed improved AUC compared to ASPECTS alone.
• Each score point increased the adjusted risk of poor outcomes by 47.8% (OR=1.48, p<0.001).
• Scores were inversely correlated with mean arterial pressure (MAP) and cerebral perfusion pressure (CPP).

Conclusions:

• The developed score system is an excellent predictor of poor functional outcomes in LHI patients post-DC.
• The score is associated with CPP and MAP, suggesting potential clinical utility.
• Further external validation is recommended before widespread clinical adoption.