• Lisa Hoogendam, Jeanne A C Bakx, J Sebastiaan Souer, Harm P Slijper, Eleni-Rosalina Andrinopoulou, Ruud W Selles, and Hand Wrist Study Group.
• Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
• Neurosurgery. 2022 Jan 1; 90 (1): 106113106-113.

BackgroundSymptom improvement is an important goal when considering surgery for carpal tunnel syndrome. There is currently no prediction model available to predict symptom improvement for patients considering a carpal tunnel release (CTR).ObjectiveTo predict using a model the probability of clinically relevant symptom improvement at 6 mo after CTR.MethodsWe split a cohort of 2119 patients who underwent a mini-open CTR and completed the Boston Carpal Tunnel Questionnaire preoperatively and 6 mo postoperatively into training (75%) and validation (25%) data sets. Patients who improved more than the minimal clinically important difference of 0.8 at the Boston Carpal Tunnel Questionnaire-symptom severity scale were classified as "improved." Logistic regression, random forests, and gradient boosting machines were considered to train prediction models. The best model was selected based on discriminative ability (area under the curve) and calibration in the validation data set. This model was further assessed in a holdout data set (N = 397).ResultsA gradient boosting machine with 5 predictors was chosen as optimal trade-off between discriminative ability and the number of predictors. In the holdout data set, this model had an area under the curve of 0.723, good calibration, sensitivity of 0.77, and specificity of 0.55. The positive predictive value was 0.50, and the negative predictive value was 0.81.ConclusionWe developed a prediction model for clinically relevant symptom improvement 6 mo after a CTR, which required 5 patient-reported predictors (18 questions) and has reasonable discriminative ability and good calibration. The model is available online and might help shared decision making when patients are considering a CTR.Copyright © Congress of Neurological Surgeons 2021. All rights reserved.

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