Prediction of Discharge Outcome with the Full Outline of Unresponsiveness (FOUR) Score in Neurosurgical Patients

To identify the diagnostic properties of the Full Outline of Unresponsiveness (FOUR) score and the discharge outcome, 318 patients were studied. The evaluators rated the patients on admission or when they had mental status alteration with the FOUR score. The course of treatment was determined based on the clinical. The mortality rate and Glasgow Outcome Scale were recorded. Adjusted regression models and prognostic performance were tested by calculation of the receiver operating characteristic curve. One-hundred and twenty-two patients (40.1%) had a poor outcome defined as a Glasgow Outcome Scale score from 3-5, and 38 patients (12.5%) died. The area under the characteristic curve (AUC) for poor outcome and in-hospital mortality were 0.88 (95% CI, 0.83-0.92) and 0.92 (95% CI, 0.87-0.97). The cut-off point of 14 showed sensitivity and specificity of the total FOUR score predicting poor outcomes at 0.77 (95% CI, 0.69-0.84) and 0.95 (95% CI, 0.90-0.97), while the cut-off point of 10 showed the values for in-hospital mortality at 0.71 (95% CI, 0.55-0.83) and 0.93 (95% CI, 0.90-0.96). The total FOUR score showed satisfactory prognostic value for predicting outcome. The cut-off points for the poor outcome and in-hospital mortality are 14 and 10, respectively

Alternative Placement of Bispectral Index Electrode for Monitoring Depth of Anesthesia during Neurosurgery

In neurosurgery in particular, the recommended placement of electrodes for monitoring depth of anesthesia during surgery sometimes conflicts with the surgical site or patient positioning. Therefore, we proposed this study to evaluate the agreement and correlation of bispectral index values recorded from the usual frontal area and the alternate, post-auricular areas in neurosurgery patients. Thirty-four patients scheduled for neurosurgery under general anesthesia were included. Bispectral index (BIS) sensors were placed at both the frontal and post-auricular areas. The anesthesia given was clinically adjusted according to the frontal (standard) BIS reading. The BIS values and impedance were recorded;Pearsonʼs correlation and Bland-Altman plots were analyzed. The bias ± 2SD for the electrode placement before, during, and post-anesthesia were 0±23.32, 1.5±10.69, and 2.1±13.52, while the limits of agreement were －23.3 to 23.3, －12.2 to 9.2, and －17.7 to 13.5, respectively. The correlation coefficient between frontal- and post-auricular-area electrodes was 0.74 with a p-value ＜0.001.The post-auricular placement of a BIS electrode is a practical alternative to frontal lobe placement. Nevertheless, proper electrode location is important to minimize error

Sustav APACHE II. kao klinički prediktor u neurokirurškoj jedinici intenzivnog liječenja

The APACHE II scoring system is approved for its benchmarking and mortality predictions, but there are only a few articles published to demonstrate it in neurosurgical patients. Therefore, this study was performed to acknowledge this score and its predictive performance to hospital mortality in a tertiary referral neurosurgical intensive care unit (ICU). All patients admitted to the Neurosurgical ICU from February 1 to July 31, 2011 were recruited. The parameters indicated in APACHE II score were collected. The adjusted predicted risk of death was calculated and compared with the death rate observed. Descriptive statistics including the receiver operating characteristic curve (ROC) was performed. The results showed that 276 patients were admitted during the mentioned period. The APACHE II score was 16.56 (95% CI, 15.84-17.29) and 19.08 (95% CI, 15.40- 22.76) in survivors and non-survivors, while the adjusted predicted death rates were 13.39% (95% CI, 11.83-14.95) and 17.49% (95% CI, 9.81-25.17), respectively. The observed mortality was only 4.35%. The area under the ROC of APACHE II score to the hospital mortality was 0.62 (95% CI, 0.44-0.79). In conclusion, not only the APACHE II score in neurosurgical patients indicated low severity, but its performance to predict hospital mortality was also inferior. Additional studies of predicting mortality among these critical patients should be undertaken.Sustav APACHE II. odobren je kao mjerilo i prediktor smrtnosti, no samo se nekoliko članaka bavi njegovom primjenom kod neurokirurških bolesnika. Stoga smo proveli ovo istraživanje kako bismo potvrdili ovaj sustav i njegovu sposobnost predviđanja bolničke smrtnosti u referentnoj tercijarnoj neurokirurškoj jedinici intenzivnog liječenja (JIL). U istraživanje su bili uključeni svi bolesnici primljeni u neurokiruršku JIL od 1. veljače do 31. srpnja 2011. godine. Prikupljeni su podaci koji se odnose na parametre sustava APACHE II. Izračunat je prilagođeni rizik smrti i uspoređen sa zabilježenom stopom smrtnosti. U analizi je primijenjena deskriptivna statistika uključujući ROC. Rezultati su pokazali da je primljeno 276 bolesnika. Zbir APACHE II. bio je 16,56 (95% CI, 15,84-17,29) za preživjele i 19,08 (95% CI, 15,40-22,76) za umrle, dok je prilagođena predviđena stopa smrtnosti bila 13,39% (95% CI, 11,83-14,95) odnosno 17,49% (95% CI, 9,81-25,17). Zabilježena stopa smrtnosti bila je samo 4,35%. Područje ispod ROC zbira APACHE II. za bolničku smrtnost iznosila je 0,62 (95% CI, 0,44-0,79). U zaključku, ne samo da je zbir APACHE II. pokazao nisku težinu kod neurokirurških bolesnika, nego je i njegov rezultat u predviđanju bolničke smrtnosti bio nezadovoljavajući. Treba provesti daljnja istraživanja prediktora smrtnosti kod ovih kritičnih bolesnika

Parameters Affecting Length of Stay Among Neurosurgical Patients in an Intensive Care Unit

Aim: to determine the predictive factors on the length of stay of neurosurgical patients in the ICU setting. Methods: all patients admitted to the neurosurgical ICU between February 1 and July 31, 2011 were recruited. Patient demographics and clinical data for each variable were collected within 30 minutes of admission. The ICU length of stay was recorded and analyzed by linear regression model with statistical significance at p-value <0.05. Results: there were 276 patients admitted, of whom 89.1% were elective cases. The mean (95% CI) and median (min-max) of ICU length of stay were 2.36 (2.09-2.63) and 2 (1-25) days. The variables associated with ICU length of stay and their percent change (95% CI) were the Glasgow Coma Scale motor subscore (GCSm), 6.72% (-11.20 to -2.01) lower for every 1 point score change; blood pH, 1.16% (0.11 to 2.21) higher for every 0.01 unit change; and emergency admission type, 58.30% (29.16 to 94.0) higher as compared to elective admission. Conclusion: the GCSm, pH and emergency admission were found to be the main predictive variables of neurosurgical patient length of stay in the intensive care unit, however, the model should be further explored in a larger sample size and using subgroup analysis

The dosage of thiopental as pharmacological cerebral protection during non-shunt carotid endarterectomy: A retrospective study [version 3; peer review: 2 approved]

Background Thiopental has been used as a pharmacological cerebral protection strategy during carotid endarterectomy surgeries. However, the optimal dosage required to induce burst suppression on the electroencephalogram (EEG) remains unknown. This retrospective study aimed to determine the optimal dosage of thiopental required to induce burst suppression during non-shunt carotid endarterectomy. Methods The Neurological Institute of Thailand Review Board approved the study. Data were collected from 2009 to 2019 for all non-shunt carotid endarterectomy patients who received thiopental for pharmacological cerebral protection and had intraoperative EEG monitoring. Demographic information, carotid stenosis severity, intraoperative EEG parameters, thiopental dosage, carotid clamp time, intraoperative events, and patient outcomes were abstracted. Results The study included 57 patients. Among them, 24 patients (42%) achieved EEG burst suppression pattern with a thiopental dosage of 26.3±10.1 mg/kg/hr. There were no significant differences in perioperative events between patients who achieved burst suppression and those who did not. After surgery, 33.3% of patients who achieved burst suppression were extubated and awakened. One patient in the non-burst suppression group experienced mild neurological deficits. No deaths occurred within one month postoperative. Conclusions The optimal dosage of thiopental required to achieve burst suppression on intraoperative EEG during non-shunt carotid endarterectomy was 26.3±10.1 mg/kg/hr

Incidence of complications associated with deep brain stimulation surgery in patients with Parkinson's disease: An 8-year retrospective study

Background: Various complications occur in patients undergoing deep brain stimulation (DBS) surgery. The objective of this study was to determine the incidence of complications in patients with Parkinson's disease who underwent DBS surgery and identify the risk factors, especially anesthetic factors. Methods: A retrospective cohort study was performed between May 2015 and December 2022. Based on a review of medical charts, patients aged 18 years or older who underwent DBS surgery at a tertiary neurological center in Thailand were recruited. Univariate analysis using the Chi-square test or Fisher's exact test was performed to compare patients with and without complications. Multivariate logistic regression analysis was performed to identify the predictive factors for complications. Results: The study included 46 patients. The most common complication during DBS electrode placement was hypertension (30/46, 65.2%), and 19 patients (41.3%) who developed hypertension did not receive antihypertensive treatment. The most common complication during battery placement was clinical hypotension (14/46, 30.4%). The most common postoperative complication was delirium (6/46, 13.0%). In the multivariate analysis, no significant independent risk factors for overall complications after DBS surgery were identified. Conclusions: Hypertension during DBS electrode insertion was the most common perioperative complication. Hemodynamic instability is preventable and manageable, and vigilant and prompt treatment should be provided during DBS surgery