The unruptured intracranial aneurysm treatment score: a multidisciplinary consensus.

Etminan, Nima; Brown, Robert D; Beseoglu, Kerim; Juvela, Seppo; Raymond, Jean; Morita, Akio; Torner, James C; Derdeyn, Colin P; Raabe, Andreas; Mocco, J; Korja, Miikka; Abdulazim, Amr; Amin-Hanjani, Sepideh; Al-Shahi Salman, Rustam; Barrow, Daniel L; Bederson, Joshua; Bonafe, Alain; Dumont, Aaron S; Fiorella, David J; Gruber, Andreas; ... (2015). The unruptured intracranial aneurysm treatment score: a multidisciplinary consensus. Neurology, 85(10), pp. 881-889. Lippincott Williams & Wilkins 10.1212/WNL.0000000000001891

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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.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Raabe, Andreas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0028-3878

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Nicole Söll

Date Deposited:

12 Apr 2016 15:17

Last Modified:

10 Nov 2016 10:33

Publisher DOI:

10.1212/WNL.0000000000001891

PubMed ID:

26276380

BORIS DOI:

10.7892/boris.80140

URI:

https://boris.unibe.ch/id/eprint/80140

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