The unruptured intracranial aneurysm treatment score: a multidisciplinary consensus.

Abstract:

OBJECTIVE:We endeavored to develop an unruptured intracranial aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among specialists in UIA management and research. METHODS:An international multidisciplinary (neurosurgery, neuroradiology, neurology, clinical epidemiology) group of 69 specialists was convened to develop and validate the UIATS model using a Delphi consensus. For internal (39 panel members involved in identification of relevant features) and external validation (30 independent external reviewers), 30 selected UIA cases were used to analyze agreement with UIATS management recommendations based on a 5-point Likert scale (5 indicating strong agreement). Interrater agreement (IRA) was assessed with standardized coefficients of dispersion (vr*) (vr* = 0 indicating excellent agreement and vr* = 1 indicating poor agreement). RESULTS:The UIATS accounts for 29 key factors in UIA management. Agreement with UIATS (mean Likert scores) was 4.2 (95% confidence interval [CI] 4.1-4.3) per reviewer for both reviewer cohorts; agreement per case was 4.3 (95% CI 4.1-4.4) for panel members and 4.5 (95% CI 4.3-4.6) for external reviewers (p = 0.017). Mean Likert scores were 4.2 (95% CI 4.1-4.3) for interventional reviewers (n = 56) and 4.1 (95% CI 3.9-4.4) for noninterventional reviewers (n = 12) (p = 0.290). Overall IRA (vr*) for both cohorts was 0.026 (95% CI 0.019-0.033). CONCLUSIONS:This novel UIA decision guidance study captures an excellent consensus among highly informed individuals on UIA management, irrespective of their underlying specialty. Clinicians can use the UIATS as a comprehensive mechanism for indicating how a large group of specialists might manage an individual patient with a UIA.

journal_name

Neurology

journal_title

Neurology

authors

Etminan N,Brown RD Jr,Beseoglu K,Juvela S,Raymond J,Morita A,Torner JC,Derdeyn CP,Raabe A,Mocco J,Korja M,Abdulazim A,Amin-Hanjani S,Al-Shahi Salman R,Barrow DL,Bederson J,Bonafe A,Dumont AS,Fiorella DJ,Gruber A,H

doi

10.1212/WNL.0000000000001891

subject

Has Abstract

pub_date

2015-09-08 00:00:00

pages

881-9

issue

10

eissn

0028-3878

issn

1526-632X

pii

WNL.0000000000001891

journal_volume

85

pub_type

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