MIS Score:Prediction Model For Minimally Invasive Surgery

Background and Purpose In China,more than ten million people suffer a stroke each year;1.5 million individuals do not survive strokes,and six to seven million people do survive them.The incidence of first-time intracerebral hemorrhage(ICH)is 27.1-77.1 per 100,000 persons per year in China,and the proportion of hemorrhagic stroke among all strokes combined is 17.1%to 55.4%,i.e.,considerably higher than the 6.5-19.6%incidence in Western populations.Intracerebral hemorrhage has a higher risk of morbidity and mortality than cerebral infarction or subarachnoid hemorrhage(SAH).In recent years,an innovative minimal invasive surgery has been increasingly used to treat spontaneous ICH in China because fewer skills are required and it has been proven highly safe.The role of surgical treatment continues to be controversial,however.Many patients with spontaneous ICH have indeed benefited from this surgery in recent years:A multi-center,randomized-controlled clinical trial designed by the Chinese National Office for Cerebrovascular Disease Prevention and Control revealed that minimally invasive surgery improves neurological function to a greater extent than conservative treatment and is,overall,a safe and practical approach to treating cerebral hemorrhage.The inclusion criteria for operation remain elusive,however.Our primary goal in conducting this study was to analyze the factors affecting the 30-day prognosis of patients who have received minimally invasive surgery plus urokinase.A simple grading scale,the MIS Scale,is proposed as a guideline under which clinical operation can be performed as effectively as possible.Methods The records of 101 patients with spontaneous intracerebral hemorrhage presenting to Qianfoshan Hospital were reviewed.All patients with invasive surgery plus urokinase were assessed on the basis of a modified Rankin scale.Score from 0-3 is considered a "good" prognosis,and from 4-6 is considered a "poor"prognosis.All variables affecting 30-day prognosis were recorded.Factors affecting their 30-day prognosis were identified by logistic regression and univariate analysis.Statistical analysis was performed in SPSS(Version 20.0);P<0.05 was considered statistically significant.A clinical grading scale,the MIS score,was developed by weighting the independent predictors based on these factors.Result Univariate analysis revealed that the factors that affect 30-day prognosis include Glasgow Coma Scale score(P<0.01),age ?80 years(P<0.05),blood glucose(P<0.01),ICH volume(P<0.01),operation time(P<0.05),and presence of intraventricular hemorrhage(P<0.001).Logistic regression revealed that the factors that affect 30-day prognosis include Glasgow Coma Scale score(P<0.05),age(P<0.05),ICH volume(P<0.01),and presence of intraventricular hemorrhage(P<0.05).The MIS score was developed accordingly;39 patients with 0-1 MIS scores had favorable prognoses,while only nine patients with 2-5 MIS scores had favorable prognoses.Conclusions The MIS score is a simple grading scale that can be utilized to select patients who are suited for minimal invasive drainage surgery.When MIS score is 0-1,minimal invasive surgery is strongly recommended for patients with spontaneous cerebral hemorrhage.The scale merits further prospective studies to fully determine its efficacy.