1
|
Antkowiak L, Stogowski P, Klepinowski T, Balinski T, Mado H, Sumislawski P, Niedbala M, Rucinska M, Nowaczyk Z, Rogalska M, Kocur D, Kasperczuk A, Sordyl R, Kloc W, Kaspera W, Kammler G, Sagan L, Rudnik A, Tabakow P, Westphal M, Mandera M. External validation of the Chicago Chiari Outcome Scale in adults with Chiari malformation type I. Neurosurg Focus 2023; 54:E3. [PMID: 36857789 DOI: 10.3171/2022.12.focus22625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/29/2022] [Indexed: 03/03/2023]
Abstract
OBJECTIVE The Chicago Chiari Outcome Scale (CCOS) serves as a standardized clinical outcome evaluation tool among patients with Chiari malformation type I (CM-I). While the reliability of this scale has been proven for pediatric patients, the literature lacks CCOS validation when used solely in adults. Therefore, this study aimed to determine the validity of the CCOS in an external cohort of adult patients. METHODS The authors retrospectively analyzed the medical records of symptomatic patients with CM-I who underwent posterior fossa decompression between 2010 and 2018 in six neurosurgical departments. Each patient was clinically assessed at the latest available follow-up. Gestalt outcome was determined as improved, unchanged, or worsened compared with the preoperative clinical state. Additionally, the CCOS score was calculated for each patient based on the detailed clinical data. To verify the ability of the CCOS to determine clinical improvement, the area under the receiver operating characteristic (AUROC) curve was evaluated. A logistic regression analysis using all four components of the CCOS (pain symptoms, nonpain symptoms, functionality, and complications) was performed to establish predictors of the improved outcome. RESULTS Seventy-five individuals with a mean age of 42 ± 15.32 years were included in the study. The mean follow-up duration was 52 ± 33.83 months. Considering gestalt outcome evaluation, 41 patients (54.7%) were classified as improved, 24 (32%) as unchanged, and 10 (13.3%) as worsened. All patients with a CCOS score of 14 or higher improved, while all those with a CCOS score of 8 or lower worsened. The AUROC was 0.986, suggesting almost perfect accuracy of the CCOS in delineating clinical improvement. A CCOS score of 13 showed high sensitivity (0.93) and specificity (0.97) for identifying patients with clinical improvement. Additionally, a meaningful correlation was found between higher CCOS scores in each component and better outcomes. Patient stratification by total CCOS score showed that those categorized as improved, unchanged, and worsened scored prevalently between 13 and 16 points, 10 and 12 points, and 4 and 9 points, respectively. CONCLUSIONS In this adult cohort, the CCOS was found to be almost perfectly accurate in reflecting postoperative clinical improvement. Moreover, all four CCOS components (pain symptoms, nonpain symptoms, functionality, and complications) significantly correlated with patient clinical outcomes.
Collapse
Affiliation(s)
- Lukasz Antkowiak
- 1Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland
| | - Piotr Stogowski
- 2Department of Neurosurgery, Copernicus Medical Center, Gdansk, Poland
| | - Tomasz Klepinowski
- 3Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Szczecin, Poland
| | - Tristan Balinski
- 4Department of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland
| | - Hubert Mado
- 1Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland
| | - Piotr Sumislawski
- 5Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcin Niedbala
- 6Department of Neurosurgery, Medical University of Silesia in Katowice, Regional Hospital, Sosnowiec, Poland
| | - Michalina Rucinska
- 1Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland
| | - Zuzanna Nowaczyk
- 3Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Szczecin, Poland
| | - Marta Rogalska
- 7Faculty of Medicine, Medical University of Warsaw, Poland
| | - Damian Kocur
- 8Department of Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland
| | - Anna Kasperczuk
- 9Faculty of Mechanical Engineering, Institute of Biomedical Engineering, Bialystok University of Technology, Bialystok, Poland
| | - Ryszard Sordyl
- 1Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland
| | - Wojciech Kloc
- 2Department of Neurosurgery, Copernicus Medical Center, Gdansk, Poland.,10Department of Psychology and Sociology of Health and Public Health, School of Public Health, Collegium Medicum, University of Warmia-Mazury in Olsztyn, Poland; and
| | - Wojciech Kaspera
- 6Department of Neurosurgery, Medical University of Silesia in Katowice, Regional Hospital, Sosnowiec, Poland
| | - Gertrud Kammler
- 5Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Leszek Sagan
- 3Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Szczecin, Poland.,11Department of Pediatric Neurosurgery, Zdroje Hospital, Szczecin, Poland
| | - Adam Rudnik
- 8Department of Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland
| | - Pawel Tabakow
- 4Department of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland
| | - Manfred Westphal
- 5Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marek Mandera
- 1Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland
| |
Collapse
|