The unruptured intracranial aneurysm treatment score: a multidisciplinary consensus.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Etminan, N; Brown, RD; 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; Hankey, GJ; Hasan, DM; Hoh, BL; Jabbour, P; Kasuya, H; Kelly, ME; Kirkpatrick, PJ; Knuckey, N; Koivisto, T; Krings, T; Lawton, MT; Marotta, TR; Mayer, SA; Mee, E; Pereira, VM; Molyneux, A; Morgan, MK; Mori, K; Murayama, Y; Nagahiro, S; Nakayama, N; Niemelä, M; Ogilvy, CS; Pierot, L; Rabinstein, AA; Roos, YBWEM; Rinne, J; Rosenwasser, RH; Ronkainen, A; Schaller, K; Seifert, V; Solomon, RA; Spears, J; Steiger, H-J; Vergouwen, MDI; Wanke, I; Wermer, MJH; Wong, GKC; Wong, JH; Zipfel, GJ; Connolly, ES; Steinmetz, H; Lanzino, G; Pasqualin, A; Rüfenacht, D; Vajkoczy, P; McDougall, C; Hänggi, D; LeRoux, P; Rinkel, GJE; Macdonald, RL

Published Date

  • September 8, 2015

Published In

Volume / Issue

  • 85 / 10

Start / End Page

  • 881 - 889

PubMed ID

  • 26276380

Pubmed Central ID

  • PMC4560059

Electronic International Standard Serial Number (EISSN)

  • 1526-632X

Digital Object Identifier (DOI)

  • 10.1212/WNL.0000000000001891


  • eng

Conference Location

  • United States