Novel Pre-therapeutic Scoring System Using Patient and Hematological Data to Predict Facial Palsy Prognosis

Abstract

Objectives

We describe a novel scoring system, the facial Palsy Prognosis Prediction score (PPP score), which we test for reliability in predicting pre-therapeutic prognosis of facial palsy. We aimed to use readily available patient data that all clinicians have access to before starting treatment.

Design

Multicenter case series with chart review.

Setting

Three tertiary care hospitals.

Participants

We obtained hematological and demographic data from 468 facial palsy patients who were treated between 2010 and 2014 in three tertiary care hospitals. Patients were categorized as having Bell's palsy or Ramsey Hunt's palsy.

Main Outcome measures

We compared the data of recovered and unrecovered patients. PPP scores consisted of combinatorial threshold values of continuous patient data (e.g., platelet count) and categorical variables (e.g., gender) that best predicted recovery. We created separate PPP scores for Bell's palsy patients (PPP-B) and for Ramsey Hunt's palsy patients (PPP-H).

Results

The PPP-B score included age (≥65 years), gender (male), and neutrophil-to-lymphocyte ratio (≥2.9). The PPP-H score included age (≥50 years), monocyte rate (≥6.0%), mean corpuscular volume (≥95 fl), and platelet count (≤200,000/μl). Patient recovery rate significantly decreased with increasing PPP scores (both PPP-B and PPP-H) in a step-wise manner. PPP scores (i.e., PPP-B score and PPP-H score) ≥2 were associated with worse than average prognosis.

Conclusions

PPP scores are useful for predicting prognosis of facial palsy before beginning treatment.

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