Faculty Opinions recommendation of Clinical grading scales in intracerebral hemorrhage.

OBJECTIVEThe authors aimed to develop the first clinical grading scale for patients with surgically treated spontaneous supratentorial intracerebral hemorrhage (ICH).METHODSA nationwide multicenter study including 401 ICH patients surgically treated by craniotomy and evacuation of a spontaneous supratentorial ICH was conducted between January 1, 2011, and December 31, 2015. All neurosurgical centers in Sweden were included. All medical records and neuroimaging studies were retrospectively reviewed. Independent predictors of 30-day mortality were identified by logistic regression. A risk stratification scale (the Surgical Swedish ICH [SwICH] Score) was developed using weighting of independent predictors based on strength of association.RESULTSFactors independently associated with 30-day mortality were Glasgow Coma Scale (GCS) score (p = 0.00015), ICH volume ≥ 50 mL (p = 0.031), patient age ≥ 75 years (p = 0.0056), prior myocardial infarction (MI) (p = 0.00081), and type 2 diabetes (p = 0.0093). The Surgical SwICH Score was the sum of individual points assigned as follows: GCS score 15–13 (0 points), 12–5 (1 point), 4–3 (2 points); age ≥ 75 years (1 point); ICH volume ≥ 50 mL (1 point); type 2 diabetes (1 point); prior MI (1 point). Each increase in the Surgical SwICH Score was associated with a progressively increased 30-day mortality (p = 0.0002). No patient with a Surgical SwICH Score of 0 died, whereas the 30-day mortality rates for patients with Surgical SwICH Scores of 1, 2, 3, and 4 were 5%, 12%, 31%, and 58%, respectively.CONCLUSIONSThe Surgical SwICH Score is a predictor of 30-day mortality in patients treated surgically for spontaneous supratentorial ICH. External validation is needed to assess the predictive value as well as the generalizability of the Surgical SwICH Score.

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Analysis of Clinical Grading Scales for the Foot and Ankle

Foot & Ankle International ◽

10.1177/107110079701800713 ◽

1997 ◽

Vol 18 (7) ◽

pp. 443-446 ◽

Cited By ~ 60

Author(s):

Harold B. Kitaoka ◽

Gary L. Patzer

Keyword(s):

Patient Satisfaction ◽

Clinical Condition ◽

Clinical Results ◽

Foot And Ankle ◽

Clinical Factors ◽

Orthopaedic Literature ◽

Before And After ◽

The Individual ◽

Grading Scales ◽

Clinical Grading

To evaluate grading methods used to report clinical results, we reviewed 1,607 articles related to the foot and ankle published in six orthopaedic journals from 1980 through July 1993. Many clinical studies use criteria such as patient satisfaction to grade results. A numeric score or grade was used in 346 articles: 238 used a grade only, 90 used a numeric score and grade, and 18 used a numeric score only. The numeric score or grade was usually, but not always, reported with details of the individual clinical factors that composed the score or grade. Twenty-three articles used a score before and after treatment. Statistics were used in 62 articles, and in 6 of those the statistics were used to compare clinical condition before and after treatment. This study demonstrated the array of grading methods used in selected orthopaedic journals and indicated the need for standardized grading techniques to allow for more meaningful interpretation of the orthopaedic literature.

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Validation of the newly conceived Surgical Swedish ICH grading scale for surgically treated patients with intracerebral hemorrhage: patient series

Journal of Neurosurgery: Case Lessons ◽

10.3171/case2044 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Johan A. Haga ◽

Frantz R. Poulsen ◽

Axel Forsse

Keyword(s):

Intracerebral Hemorrhage ◽

Area Under Curve ◽

Mortality Rates ◽

Patient Records ◽

Patient Series ◽

Grading Scale ◽

One Year ◽

Ich Score ◽

Receiver Operator Characteristics ◽

Clinical Grading

BACKGROUNDThe authors sought to externally validate a newly developed clinical grading scale, the Surgical Swedish ICH (SwICH) score. Patients surgically treated for spontaneous supratentorial intracerebral hemorrhage (ICH) from 2009 to 2019 in a single center in Denmark were identified. Data were retrospectively collected from patient records and neuroimaging. Surgical SwICH and ICH scores were calculated for each patient, and the validity of the Surgical SwICH was assessed and compared.OBSERVATIONSThe 126 patients included had an overall 30-day mortality rate of 23%. All patients with a Surgical SwICH score of 0 survived past one year. No patient scored the maximum Surgical SwICH score of 6. The 30-day mortality rates for Surgical SwICH scores 1, 2, 3, and 4 were 0%, 20%, 53%, and 25%, respectively (p <0.0001 for trend). Mortality rates for ICH scores 1, 2, 3, and 4 were 0%, 11%, 33%, and 76%, respectively (p <0.001 for trend). Receiver operator characteristics showed an area under curve of 0.78 for the Surgical SwICH score and 0.80 for the ICH score (p = 0.21 difference).LESSONSThe Surgical SwICH score was a good predictor of 30-day mortality in patients surgically treated for spontaneous supratentorial ICH. However, the Surgical SwICH score did not outperform the previously established ICH score in predicting 30-day mortality.

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Management of comminuted patellar fracture fixation using modified cerclage wiring

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1385-5 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Yangyang Sun ◽

Kuisheng Sheng ◽

Qinghu Li ◽

Dawei Wang ◽

Dongsheng Zhou

Keyword(s):

Postoperative Complications ◽

Internal Fixation ◽

Fracture Fixation ◽

Patellar Fracture ◽

Active Flexion ◽

Cerclage Wiring ◽

Mean Time ◽

Grading Scales ◽

Clinical Grading

Abstract Background Although there are several different kinds of fixation techniques for displaced comminuted patellar fracture, the treatment remains a challenge for orthopaedic surgeons. The purpose of this study is to evaluate the effectiveness and safety of a fixation technique for comminuted patellar fracture fixation using modified cerclage wiring. Methods From February 2016 to April 2018, 38 cases of simple unilateral closed comminuted patellar fracture were treated by modified cerclage wiring. Among these cases, 16 patients were males and 22 were females, aged 23–68 years (average 40.4 ± 9.1 years). Comminuted patellar fractures were classified according to the AO/OTA classification: 10 cases were type 34-C2 (three fragments), 28 cases were type 34-C3 (more than three fragments). Postoperative complications including loosening of internal fixation, fragment re-displacement, nonunion, infection, breakage of internal fixation and traumatic osteoarthritis were assessed. The clinical results after operation were evaluated by the clinical grading scales of Böstman including range of movement, pain, work, atrophy, assistance in walking, effusion, giving way, and stair-climbing during follow-up. Results A total of 38 patients were followed up for 6–36 months (mean time 16.1 ± 5.8 months). The bone union radiographically occurred at approximately 2.5–3.5 months (mean time 2.92 ± 0.25 months). No postoperative complications, such as infection, dislocation, breakage of the implants, painful hardware, and post-traumatic osteoarthritis, were observed. According to the clinical grading scales of Böstman, satisfactory results were obtained, and the mean score at the final follow-up was 28.7 (range 20–30) points. Thirty-two patients (84.2%) with excellent results had a mean score of 29.5 ± 0.7 (range 28–30) points, and six patients (15.8%) with good results had a mean score of 24.5 ± 2.2 (range 20–27) points. The patients with excellent and good scores had active flexion of 130° (110–140). Conclusions Modified cerclage wiring can effectively treat comminuted patellar fracture and offers a new strategy resulting in satisfactory results without obvious complications.

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