1Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland.
2Department of Neurosurgery, Copernicus Medical Center, Gdansk, Poland.
Neurosurg Focus. 2023 Mar;54(3):E3. doi: 10.3171/2022.12.FOCUS22625.
The Chicago Chiari Outcome Scale (CCOS) serves as a standardized clinical outcome evaluation tool among patients with Chiari malformation type I (CM-I). While the reliability of this scale has been proven for pediatric patients, the literature lacks CCOS validation when used solely in adults. Therefore, this study aimed to determine the validity of the CCOS in an external cohort of adult patients.
The authors retrospectively analyzed the medical records of symptomatic patients with CM-I who underwent posterior fossa decompression between 2010 and 2018 in six neurosurgical departments. Each patient was clinically assessed at the latest available follow-up. Gestalt outcome was determined as improved, unchanged, or worsened compared with the preoperative clinical state. Additionally, the CCOS score was calculated for each patient based on the detailed clinical data. To verify the ability of the CCOS to determine clinical improvement, the area under the receiver operating characteristic (AUROC) curve was evaluated. A logistic regression analysis using all four components of the CCOS (pain symptoms, nonpain symptoms, functionality, and complications) was performed to establish predictors of the improved outcome.
Seventy-five individuals with a mean age of 42 ± 15.32 years were included in the study. The mean follow-up duration was 52 ± 33.83 months. Considering gestalt outcome evaluation, 41 patients (54.7%) were classified as improved, 24 (32%) as unchanged, and 10 (13.3%) as worsened. All patients with a CCOS score of 14 or higher improved, while all those with a CCOS score of 8 or lower worsened. The AUROC was 0.986, suggesting almost perfect accuracy of the CCOS in delineating clinical improvement. A CCOS score of 13 showed high sensitivity (0.93) and specificity (0.97) for identifying patients with clinical improvement. Additionally, a meaningful correlation was found between higher CCOS scores in each component and better outcomes. Patient stratification by total CCOS score showed that those categorized as improved, unchanged, and worsened scored prevalently between 13 and 16 points, 10 and 12 points, and 4 and 9 points, respectively.
In this adult cohort, the CCOS was found to be almost perfectly accurate in reflecting postoperative clinical improvement. Moreover, all four CCOS components (pain symptoms, nonpain symptoms, functionality, and complications) significantly correlated with patient clinical outcomes.
芝加哥后颅凹 Chiari 畸形结局量表（CCOS）是 Chiari 畸形 I 型（CM-I）患者的一种标准化临床结局评估工具。该量表已被证实适用于儿科患者，但其在单纯成人患者中的有效性在文献中尚缺乏验证。因此，本研究旨在确定 CCOS 在外部成人患者队列中的有效性。
作者回顾性分析了 2010 年至 2018 年期间在 6 个神经外科部门接受后颅凹减压术的有症状 CM-I 患者的病历。每位患者在最近一次随访时进行临床评估。根据术前临床状态，将结局判断为改善、不变或恶化。此外，根据详细的临床数据，为每位患者计算 CCOS 评分。为了验证 CCOS 确定临床改善的能力，评估了受试者工作特征（ROC）曲线下面积（AUROC）。使用 CCOS 的四个组成部分（疼痛症状、非疼痛症状、功能和并发症）进行逻辑回归分析，以确定改善结局的预测因素。
研究纳入了 75 名平均年龄为 42±15.32 岁的患者。平均随访时间为 52±33.83 个月。根据整体结局评估，41 名患者（54.7%）被归类为改善，24 名（32%）为不变，10 名（13.3%）为恶化。CCOS 评分≥14 的所有患者均改善，CCOS 评分≤8 的所有患者均恶化。AUROC 为 0.986，表明 CCOS 对描绘临床改善具有近乎完美的准确性。CCOS 评分 13 分对识别临床改善的患者具有较高的敏感性（0.93）和特异性（0.97）。此外，每个组成部分的 CCOS 评分较高与更好的结局之间存在显著相关性。根据总 CCOS 评分对患者进行分层，发现改善、不变和恶化组的患者得分分别主要为 13 至 16 分、10 至 12 分和 4 至 9 分。
在本成年患者队列中，CCOS 被发现对反映术后临床改善具有近乎完美的准确性。此外，CCOS 的所有四个组成部分（疼痛症状、非疼痛症状、功能和并发症）均与患者的临床结局显著相关。
