title: Preoperative APACHE II and GCS scores as predictors of outcomes in patients with malignant MCA infarction after decompressive hemicraniectomy.
abstract: OBJECTIVE
  Decompressive hemicraniectomy is accepted as the most effective life-saving treatment for malignant middle cerebral artery (MCA) infarction. However, the outcome remains hard to predict. This study examined the efficacy of using the Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores before emergency craniectomy for predicting clinical outcome in malignant MCA infarction.
  
  
  METHODS
  Seventy-nine consecutive patients with malignant MCA infarction treated from January 2006 to October 2010 were retrospectively analyzed. The GCS and APACHE II scores within the first 24 h of neurological deterioration or before decompressive hemicraniectomy, were used to predict short-term functional outcome rated by the modified Rankin Scale (mRS). The receiver operating characteristic (ROC) curve was obtained to determine the accuracy and best cut-off value for each scoring system.
  
  
  RESULTS
  At 6 months, there was dramatic life-saving effect of surgery, with a significant reduction in mortality rate (from 71% to 19%, P < 0.001). After the ROC analysis, cut-off values of pre-operative GCS > 8 (P = 0.003) and APACHE II <13 (P = 0.006) were sufficiently sensitive and specific to predict favorable outcome (mRS 0-3).
  
  
  CONCLUSIONS
  Pre-operative GCS and APACHE II scores are useful tools in predicting outcomes for patients with malignant MCA infarction who underwent decompressive hemicraniectomy.
authors.affiliation: Department of Neurological Surgery, Tri Service General Hospital, Taiwan, China.
authors.forename: Chia-Lin
authors.initials: CL
authors.lastname: Tsai
authors.forename: Hsin
authors.initials: H
authors.lastname: Chu
authors.forename: Giia-Sheun
authors.initials: GS
authors.lastname: Peng
authors.forename: Hsin-I
authors.initials: HI
authors.lastname: Ma
authors.forename: Chun-An
authors.initials: CA
authors.lastname: Cheng
authors.forename: Dueng-Yuan
authors.initials: DY
authors.lastname: Hueng
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D007839:Functional Laterality; D015600:Glasgow Coma Scale; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012372:ROC Curve; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome