Clinical Risk Score for Prediction of Urgency in Carotid Cavernous Sinus Fistulas

Figures & data

Table 1 Logistic Regression Analysis of Clinical Characteristics of CCF Patients

Variables	Direct CCFs (n = 28)	Dural CCFs (n = 32)	Odds Ratio (95% CI)	p-value	AuROC
Age (years) mean ± SD	31.32 ± 13.52	61.25 ± 9.94	1.21 (1.09, 1.33)	<0.001	0.9509
VA (logMAR) mean ± SD	1.04 ± 1.05	0.42 ± 0.55	2.75 (1.22, 6.20)	0.015	0.6607
IOP (mmHg) mean ± SD	22.93 ± 8.18	21.69 ± 8.79	1.02 (0.96, 1.08)	0.569	0.5385
Female	12 (42.9)	23 (71.9)	3.45 (1.16, 9.98)	0.025	0.6451
Trauma	26 (92.9)	5 (15.6)	70.2 (12.5, 394.39)	<0.001	0.8862
Underlying diseases	3 (10.71)	17 (53.13)	9.44 (2.37, 37.7)	0.001	0.7121
Diplopia	5 (17.9)	7 (21.9)	1.29 (0.36, 4.63)	0.698	0.5201
Blurred vision	17 (60.7)	12 (37.5)	2.58 (0.91, 7.31)	0.075	0.6161
Orbital pain	14 (50.0)	13 (40.6)	1.46 (0.53, 4.07)	0.467	0.5469
External ophthalmoplegia	20 (71.4)	20 (62.5)	1.5 (0.51, 4.45)	0.465	0.5446
Proptosis	24 (85.7)	20 (62.5)	3.3 (0.91, 11.98)	0.069	0.6060
Orbital bruit	19 (67.9)	4 (12.5)	14.78 (3.97, 54.99)	<0.001	0.7768
Dilated episcleral vessels	27 (96.4)	30 (93.8)	1.8 (0.15, 20.99)	0.639	0.5134
Chemosis	18 (64.3)	9 (28.1)	4.6 (1.54, 13.70)	0.006	0.6808
Ptosis	2 (7.1)	2 (6.3)	1.15 (0.15, 8.78)	0.890	0.5045
Blood in Schlemm’s canal	7 (25.0)	5 (15.6)	3.52 (0.76, 16.39)	0.109	0.6514
Dilated retinal veins	12 (42.9)	4 (12.5)	5.2 (1.42, 19.04)	0.013	0.6556
Disc swelling	4 (14.3)	2 (6.3)	2.43 (0.41, 14.51)	0.328	0.5407
Intraretinal hemorrhage	3 (10.7)	2 (6.3)	1.75 (0.27, 11.36)	0.59	0.5222

Abbreviations: AuROC, area under the receiver operating characteristic; CCFs, carotid cavernous sinus fistulas; CI, confidence interval; IOP, intraocular pressure; SD, standard deviation; VA, visual acuity.

Figure 1 Area under the receiver operating characteristic curve of 5 significant predictors on the prediction of direct carotid cavernous sinus fistulas.

Table 2 Significant Clinical Predictors and Assigned Item Score

Predictors	Odds Ratio	95% CI	P value	Coefficient	Score
Age (years)
>55	1.00	Reference	–	–	0
45–55	7.5	0.98, 57.14	0.052	2.01	2
<45	143.75	18.69, 1105.67	<0.001	4.97	5
Trauma
No	1.00	Reference	–	–	0
Yes	70.2	12.5, 394.39	<0.001	4.25	4
Orbital Bruit
No	1.00	Reference	–	–	0
Yes	14.78	3.97, 54.99	<0.001	2.69	2.5
Underlying diseases
Yes	1.00	Reference	–	–	0
No	9.09	2.38, 33.33	0.001	2.25	2
VA (logMAR)
<0.5	1.00	Reference	–	–	0
0.5–1.0	1.76	0.55, 5.58	0.338	0.57	0.5
>1.0	19	2.08, 173.72	0.009	2.94	3

Abbreviations: CI, confidence interval; logMAR, logarithm of the minimum angle of resolution; VA, visual acuity.

Table 3 Distribution of Clinical Risk Score in Patients with Direct and Dural Carotid Cavernous Sinus Fistulas

Total Risk Score	Direct CCFs	Dural CCFs	Total
0	0	5	5
0.5	0	4	4
2	1	8	9
2.5	0	1	1
3	0	1	1
4	0	2	2
4.5	0	5	5
5	0	3	3
6	0	1	1
7	1	2	3
9.5	1	0	1
10	1	0	1
11	3	0	3
11.5	3	0	3
13.5	7	0	7
14	7	0	7
16.5	4	0	4
Total	28	32	60

Abbreviation: CCFs, carotid cavernous sinus fistulas.

Figure 2 Distribution of clinical risk score in patients with direct and dural carotid cavernous sinus fistulas.

Figure 3 Area under the receiver operating characteristic curve of clinical risk score on the prediction of direct carotid cavernous sinus fistulas.

Table 4 Sensitivity, Specificity and Positive Predictive Value in Diagnostic Prediction by Clinical Risk Score

Risk Group	Score	Direct	Dural	Sensitivity % (95% CI)	Specificity % (95% CI)	PPV % (95% CI)
Low	<5	1	26	3.57 (0.09, 18.3)	18.8 (7.21, 36.4)	3.7 (0.09, 19)
Moderate	5–10	3	6	10.7 (2.27, 28.2)	81.3 (63.6, 92.8)	33.3 (7.49, 70.1)
High	>10	24	0	85.7 (67.3, 96)	100 (89.1, 100)	100 (85.8, 100)

Abbreviations: CI, confidence interval; PPV, positive predictive value.