The Chiari Severity Index: A Preoperative Grading System for Chiari Malformation Type 1
The Chiari Severity Index: A Preoperative Grading System for Chiari Malformation Type 1
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DOI：
10.1227/neu.0000000000000608
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发表时间：
2015-03-01
期刊：
影响因子：
4.8
通讯作者：
Limbrick, David D.
中科院分区：
文献类型：
--
作者：
Greenberg, Jacob K.;Yarbrough, Chester K.;Limbrick, David D.
背景：为了制定1型Chiari畸形（CM-1）的循证治疗指南，需要能够将患者分层进行比较试验的术前预后指标。目的：建立一种综合临床和神经影像学特征的术前Chiari严重程度指数（CSI），最能预测CM-1手术后患者定义的长期生活质量改善（QOL）。方法：记录术前临床（如头痛、脊髓症状）和神经影像学（如鼻咽大小、扁桃体下降）特征。进行简短的随访调查，以评估患者定义的总体生活质量改善情况。我们使用顺序隔离来开发临床和神经影像学分级系统，并使用联合巩固来整合这些指标以形成CSI。我们使用Cochran-Armitage检验评估统计学显著性，使用C统计量评估辨别性。结果：我们的样本包括158例患者。序贯隔离将头痛特征和脊髓症状确定为最具影响力的临床参数，由此产生了一个临床分级系统，其改进率从81%（1级）到58%（3级）不等（P = 0.01）。基于顺序隔离，神经影像学分级系统仅包括syrinx >= 6 mm的存在（改善55%）或不存在（改善74%）（P = 0.049）。综合临床和神经影像学指标，CSI的改善率从83%（1级）到45%（3级）不等（P = 0.002）。联合CSI比单独使用临床（c = 0.62）或神经影像学（c = 0.58）系统具有较好的鉴别能力（c = 0.66）。结论：综合临床和神经影像学特征，CSI是一种预测CM-1手术后患者自定义改善的新工具。CSI可以帮助术前咨询和在比较有效性试验中对患者进行分层。
BACKGROUND: To develop evidence-based treatment guidelines for Chiari malformation type 1 (CM-1), preoperative prognostic indices capable of stratifying patients for comparative trials are needed.OBJECTIVE: To develop a preoperative Chiari Severity Index (CSI) integrating the clinical and neuroimaging features most predictive of long-term patient-defined improvement in quality of life (QOL) after CM-1 surgery.METHODS: We recorded preoperative clinical (eg, headaches, myelopathic symptoms) and neuroimaging (eg, syrinx size, tonsillar descent) characteristics. Brief follow-up surveys were administered to assess overall patient-defined improvement in QOL. We used sequential sequestration to develop clinical and neuroimaging grading systems and conjunctive consolidation to integrate these indices to form the CSI. We evaluated statistical significance using the Cochran-Armitage test and discrimination using the C statistic.RESULTS: Our sample included 158 patients. Sequential sequestration identified headache characteristics and myelopathic symptoms as the most impactful clinical parameters, producing a clinical grading system with improvement rates ranging from 81% (grade 1) to 58% (grade 3) (P =.01). Based on sequential sequestration, the neuroimaging grading system included only the presence (55% improvement) or absence (74% improvement) of a syrinx >= 6 mm (P =.049). Integrating the clinical and neuroimaging indices, improvement rates for the CSI ranged from 83% (grade 1) to 45% (grade 3) (P =.002). The combined CSI had moderately better discrimination (c = 0.66) than the clinical (c = 0.62) or neuroimaging (c = 0.58) systems alone.CONCLUSION: Integrating clinical and neuroimaging characteristics, the CSI is a novel tool that predicts patient-defined improvement after CM-1 surgery. The CSI may aid preoperative counseling and stratify patients in comparative effectiveness trials.