A new severity scoring system designed for the management of adult spinal tuberculosis—a retrospective case series study

Abstract Background: Surgeons have been successfully handle with spinal tuberculosis via conservative or surgical treatment. However, There are quite few classifications or scoring systems concerning spinal tuberculosis to guide the surgeons to manage the complicated pattern of spinal tuberculosis. The purpose of this study is to design a practical, yet comprehensive, severity scoring system for spinal tuberculosis that helps in clinical decision-making in terms of the need for operative versus non-operative management.Methods: A group of 129 spinal tuberculosis cases (70 male and 59 female patients) successfully treated and followed up for at least 2 years were retrospectively reviewed. Clinical spine experts from our institutions were gathered to confirm the information they considered pivotal in the communication of spinal tuberculosis and the clinical decision-making process. Typical spinal tuberculosis patterns were reviewed and reconsidered in view of these essential characteristics. An initial validation process to determine the reliability and validity of this system was also undertaken. Results: A new severity scoring system was designed based on three essential characteristics: 1) the stability of spinal infectious segments determined by imaging appearance, 2) the cause of spinal cord compression and the severity of neurologic deficit, and 3) the efficacy of the anti-tuberculosis drug therapy. A severity score was calculated from these characteristics, which divided patients into surgical and nonsurgical treatment groups. Conclusions: The severity scoring system comprehensively considers features cited in the literature including prediction of spinal stability and kyphosis deformity progression, identification of neurologic compromise and characteristics of mechanical compression of spinal cord. This classification system is intended to facilitate clinical decision-making in the management of adult spinal tuberculosis (from C3 to L5 segments) . The severity scoring system may help to improve the communication among spine surgeons. Further studies are needed to determine the reliability and validity of this system.

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INNV-34. PATTERNS OF FAILURE AND DEVELOPMENT OF A NOVEL PROGNOSTIC SCORING SYSTEM IN ELDERLY PATIENTS WITH GLIOBLASTOMA – FOLLOW UP ON 10 YEAR ANALYSIS OF THE BC CANCER AGENCY POPULATION

Neuro-Oncology ◽

10.1093/neuonc/noz175.575 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi137-vi137

Author(s):

Jonathan Zeng ◽

Kimberly DeVries ◽

Andra Krauze

Keyword(s):

Decision Making ◽

Scoring System ◽

Clinical Decision Making ◽

Radiographic Progression ◽

Clinical Decision ◽

Patient Stratification ◽

Patterns Of Failure ◽

Resection Status ◽

Cancer Agency

Abstract PURPOSE Glioblastomas (GBM) are the most common primary brain tumour recurring in most patients despite maximal management. Patient selection for appropriate treatment modality remains challenging resulting in heterogeneity in management. We examined the patterns of failure and developed a scoring system for patient stratification to optimise clinical decision making. METHODS 822 adults (BC Cancer Agency registry) diagnosed 2005–2015 age ≥60 with histologically confirmed GBM ICD-O-3 codes (9440/3, 9441/3, 9442/3) were reviewed. Univariate and Kaplan-Meier analysis were performed. Performance status (PS), age and resection status were assigned a score, cummulative maximal (favorable) score of 10 and minimum (unfavorable) score of 3. Patterns of failure were further analysed in the subset of patients with radiographic follow-up. RESULTS PS score of 3(KPS >80, ECOG 0/1), 2 (KPS 60–70, ECOG 2), 1 (KPS < 60, ECOG 3/4) (median OS 11, 6, 3 months respectively), age score and resection status were prognostic for OS with PS resulting in the most significant curve separation (p< 0.0001). Biopsy as compared to STR/GTR resulted in poorer OS in patients over 70 (age score 1/2) but had less impact in patients younger than 70 (age scores 3/4). The median OS for cumulative scores of 9/10 (123 patients), 7/8 (286 patients), 5/6 (313 patients), and 3/4 (55 patients) were 14, 8, 4 and 2 months respectively (p< 0.0001) allowing for stratification into 4 prognostic groups. 133 patients had >3 MRIs following diagnosis allowing for clinical and radiographic analysis of progression. Clinical/radiographic progression occurred within 3 months (29%/45%), 6 months (50%/66%), 9 months (70%/81%). Progression type (radiographic, clinical, both was not associated with OS. CONCLUSION Our novel prognostic scoring system is effective in achieving patient stratification and may guide clinical decision making. Early radiographic progression appears to precede clinical deterioration and may represent true progression in the elderly.

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Optimizing Clinical Decision Making in Acute Traumatic Spinal Cord Injury

Journal of Neurotrauma ◽

10.1089/neu.2016.4926 ◽

2017 ◽

Vol 34 (20) ◽

pp. 2841-2842 ◽

Cited By ~ 7

Author(s):

Michael G. Fehlings ◽

Vanessa K. Noonan ◽

Derek Atkins ◽

Anthony S. Burns ◽

Christiana L. Cheng ◽

...

Keyword(s):

Decision Making ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Clinical Decision Making ◽

Clinical Decision ◽

Traumatic Spinal Cord Injury ◽

Cord Injury

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Molecular Diagnostics in Pediatric Brain Tumors: Impact on Diagnosis and Clinical Decision-Making — A Selected Case Series

Klinische Pädiatrie ◽

10.1055/a-0637-9653 ◽

2018 ◽

Vol 230 (06) ◽

pp. 305-313 ◽

Cited By ~ 1

Author(s):

Heidi Bächli ◽

Jonas Ecker ◽

Cornelis van Tilburg ◽

Dominik Sturm ◽

Florian Selt ◽

...

Keyword(s):

Decision Making ◽

Molecular Diagnostics ◽

Clinical Management ◽

Clinical Decision Making ◽

Case Series ◽

Clinical Decision ◽

Cns Tumors ◽

Molecular Testing ◽

Cancer Predisposition Syndrome ◽

Pediatric Cns Tumors

AbstractCentral nervous system (CNS) tumors account for the highest mortality among pediatric malignancies. Accurate diagnosis is essential for optimal clinical management. The increasing use of molecular diagnostics has opened up novel possibilities for more precise classification of CNS tumors. We here report a single-institutional collection of pediatric CNS tumor cases that underwent a refinement or a change of diagnosis after completion of molecular analysis that affected clinical decision-making including the application of molecularly informed targeted therapies. 13 pediatric CNS tumors were analyzed by conventional histology, immunohistochemistry, and molecular diagnostics including DNA methylation profiling in 12 cases, DNA sequencing in 8 cases and RNA sequencing in 3 cases. 3 tumors had a refinement of diagnosis upon molecular testing, and 6 tumors underwent a change of diagnosis. Targeted therapy was initiated in 5 cases. An underlying cancer predisposition syndrome was detected in 5 cases. Although this case series, retrospective and not population based, has its limitations, insight can be gained regarding precision of diagnosis and clinical management of the patients in selected cases. Accuracy of diagnosis was improved in the cases presented here by the addition of molecular diagnostics, impacting clinical management of affected patients, both in the first-line as well as in the follow-up setting. This additional information may support the clinical decision making in the treatment of challenging pediatric CNS tumors. Prospective testing of the clinical value of molecular diagnostics is currently underway.

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Best practice guidelines for management of spinal disorders in skeletal dysplasia

10.21203/rs.2.23876/v1 ◽

2020 ◽

Author(s):

Klane White ◽

Michael B Bober ◽

Tae-Joon Cho ◽

Michael J Goldberg ◽

Julie Hoover-Fong ◽

...

Keyword(s):

Decision Making ◽

Practice Guidelines ◽

Skeletal Dysplasia ◽

Best Practice ◽

Clinical Decision Making ◽

Case Series ◽

Clinical Decision ◽

Spinal Disorders ◽

Best Practice Guidelines ◽

Group A

Abstract Background: Disorders of the spine present a common and difficult management concern in patients with skeletal dysplasia. Due to the rarity of these conditions however, the literature, largely consisting of small, single institution case series, is sparse in regard to well-designed studies to support clinical decision making in these situations. Methods: Using the Delphi method, an international, multi-disciplinary group of individuals, with significant experience in the care of patients with skeletal dysplasia, convened to develop multi-disciplinary, “best practice” guidelines in the care of spinal disorders in patients with skeletal dysplasia. Results: Starting with 33 statements, the group a developed a list of 31 “best practice” guidelines. Conclusions: The guidelines are presented and discussed to provide context for clinicians in their decision making in this often-challenging realm of care.

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