Cinotti et al reported a model for predicting complications following a craniotomy for a brain tumor. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple French hospitals participating in the SocieteFrancaised'Anesthesie-Reanmination (SFAR) Research Network.
Patient selection: craniotomy for a brain tumor
Outcomes: severe postoperative complications (intracerebral bleeding that requires evacuation, intracranial hypertension, seizures, need for tracheal intubation and mechanical ventilation, GCS <= 13, unmanageable agitation, severe swallowing disorder with aspiration, unexpected severe motor deficit, death)
Parameters:
(1) Glasgow coma scale (GCS) prior to surgery
(2) history of previous brain tumor surgery
(3) maximum size of tumor in brain imaging in mm
(4) midine shift in brain imaging in mm
(5) transfusion of a blood product (RBCs, plasma, platelets)
(6) maximum systolic blood pressure in mm Hg
(7) minimum systolic blood pressure in mm Hg
(8) duration of surgery in hours
|
Parameter
|
Finding
|
beta-coefficients
|
|
GCS
|
15
|
0
|
|
|
3 to 14
|
1.5149
|
|
previous brain surgery
|
no
|
0
|
|
|
yes
|
1.0534
|
|
maximum size
|
|
0.00878 * (diameter)
|
|
midline shift
|
< 3 mm
|
0
|
|
|
>= 3 mm
|
0.5114
|
|
transfusion
|
no
|
0
|
|
|
yes
|
0.5164
|
|
maximum systolic BP
|
|
0.0118 * (SBP)
|
|
minimum systolic BP
|
|
-0.013 * (SBP)
|
|
duration
|
|
0.2981 * (hours)
|
value of X =
= SUM(beta-coefficients) - 4.8094
probability of severe postoperative complication in the 24 hours after surgery =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve is 0.73.
