Reponen et al used the patient's responses to 3 simple questions to predict adverse outcomes following elective cranial neurosurgery. These can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Helsinki.

Patient selection: elective cranial neurosurgery


Outcome: major morbidity associated with surgery



(1) able to climb 2 flights of stairs without resting (2 flights of stairs is equivalent to going up 1 story for a distance >= 4 vertical meters)

(2) perception of overall health prior to surgery (excellent, good, average, poor or very poor)

(3) preoperative "Test your Memory" score


Risk factors for poor outcome:

(1) unable to climb 2 flights of stairs

(2) considered overall health poor or very poor

(3) any degree of cognitive impairment


Each risk factor was score 0 if absent or 1 if present.



minimum number of risk factors: 0

maximum number of risk factors: 3

The presence of at least one risk factor was associated with major complications in 66%.

The presence of no risk factors was associated with a major complication rate of 9%.



The area under the ROC curve was 0.68 but was 0.73 if the patient was >=65.

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