The unruptured intracranial aneurysm treatment score: A multidis ciplinary consensus

N. Etminan; R.D. Brown; K. Beseoglu; S. Juvela; J. Raymond; A. Morita; J.C. Torner; C.P. Derdeyn; A. Raabe; J. Mocco; M. Korja; A. Abdulazim; S. Amin-Hanjani; R.A.S. Salman; D.L. Barrow; J. Bederson; A. Bonafe; A.S. Dumont; D.J. Fiorella; A. Gruber; Graeme J. Hankey; D.M. Hasan; B.L. Hoh; P. Jabbour; H. Kasuya; M.E. Kelly; P.J. Kirkpatrick; N. Knuckey; T. Koivisto; T. Krings; M.T. Lawton; T.R. Marotta; S.A. Mayer; E. Mee; V.M. Pereira; A. Molyneux; M.K. Morgan; K. Mori; Y. Murayama; S. Nagahiro; N. Nakayama; M. Niemelä; C.S. Ogilvy; L. Pierot; A.A. Rabinstein; Y.B.W.E.M. Roos; J. Rinne; R.H. Rosenwasser; A. Ronkainen; K. Schaller; V. Seifert; R.A. Solomon; J. Spears; H.J. Steiger; M.D.I. Vergouwen; I. Wanke; M.J.H. Wermer; G.K.C. Wong; J.H. Wong; G.J. Zipfel; E. Sander Connolly; H. Steinmetz; G. Lanzino; A. Pasqualin; D. Rüfenacht; P. Vajkoczy; C. Mcdougall; D. Hänggi; P. Leroux; G.J.E. Rinkel; R. Loch Macdonald

doi:10.1212/WNL.0000000000001891

The unruptured intracranial aneurysm treatment score: A multidis ciplinary consensus

N. Etminan, R.D. Brown, K. Beseoglu, S. Juvela, J. Raymond, A. Morita, J.C. Torner, C.P. Derdeyn, A. Raabe, J. Mocco, M. Korja, A. Abdulazim, S. Amin-Hanjani, R.A.S. Salman, D.L. Barrow, J. Bederson, A. Bonafe, A.S. Dumont, D.J. Fiorella, A. GruberGraeme J. Hankey, D.M. Hasan, B.L. Hoh, P. Jabbour, H. Kasuya, M.E. Kelly, P.J. Kirkpatrick, N. Knuckey, T. Koivisto, T. Krings, M.T. Lawton, T.R. Marotta, S.A. Mayer, E. Mee, V.M. Pereira, A. Molyneux, M.K. Morgan, K. Mori, Y. Murayama, S. Nagahiro, N. Nakayama, M. Niemelä, C.S. Ogilvy, L. Pierot, A.A. Rabinstein, Y.B.W.E.M. Roos, J. Rinne, R.H. Rosenwasser, A. Ronkainen, K. Schaller, V. Seifert, R.A. Solomon, J. Spears, H.J. Steiger, M.D.I. Vergouwen, I. Wanke, M.J.H. Wermer, G.K.C. Wong, J.H. Wong, G.J. Zipfel, E. Sander Connolly, H. Steinmetz, G. Lanzino, A. Pasqualin, D. Rüfenacht, P. Vajkoczy, C. Mcdougall, D. Hänggi, P. Leroux, G.J.E. Rinkel, R. Loch Macdonald

Research output: Contribution to journal › Article › peer-review

305 Citations (Scopus)

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 (v(r)*) (v(r)* 5 0 indicating excellent agreement and v(r)* = 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 (v(r)*) 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.

Original language	English
Pages (from-to)	881-889
Number of pages	9
Journal	Neurology
Volume	85
Issue number	10
DOIs	https://doi.org/10.1212/WNL.0000000000001891 https://doi.org/10.1212/WNL.0000000000001891
Publication status	Published - 8 Sept 2015

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Etminan, N., Brown, R. D., Beseoglu, K., Juvela, S., Raymond, J., Morita, A., Torner, J. C., Derdeyn, C. P., Raabe, A., Mocco, J., Korja, M., Abdulazim, A., Amin-Hanjani, S., Salman, R. A. S., Barrow, D. L., Bederson, J., Bonafe, A., Dumont, A. S., Fiorella, D. J., ... Loch Macdonald, R. (2015). The unruptured intracranial aneurysm treatment score: A multidis ciplinary consensus. Neurology, 85(10), 881-889. https://doi.org/10.1212/WNL.0000000000001891, https://doi.org/10.1212/WNL.0000000000001891

@article{1c6e8fbb9cbe4d1bbe0db2c2fb0ea212,

title = "The unruptured intracranial aneurysm treatment score: A multidis ciplinary 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 (v(r)*) (v(r)* 5 0 indicating excellent agreement and v(r)* = 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 (v(r)*) 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.",

keywords = "TERM-FOLLOW-UP, NATURAL-HISTORY, ENDOVASCULAR TREATMENT, SACCULAR ANEURYSMS, SURGICAL-TREATMENT, RUPTURE RISK, METAANALYSIS, COHORT, AGE, MANAGEMENT",

author = "N. Etminan and R.D. Brown and K. Beseoglu and S. Juvela and J. Raymond and A. Morita and J.C. Torner and C.P. Derdeyn and A. Raabe and J. Mocco and M. Korja and A. Abdulazim and S. Amin-Hanjani and R.A.S. Salman and D.L. Barrow and J. Bederson and A. Bonafe and A.S. Dumont and D.J. Fiorella and A. Gruber and Hankey, {Graeme J.} and D.M. Hasan and B.L. Hoh and P. Jabbour and H. Kasuya and M.E. Kelly and P.J. Kirkpatrick and N. Knuckey and T. Koivisto and T. Krings and M.T. Lawton and T.R. Marotta and S.A. Mayer and E. Mee and V.M. Pereira and A. Molyneux and M.K. Morgan and K. Mori and Y. Murayama and S. Nagahiro and N. Nakayama and M. Niemel{\"a} and C.S. Ogilvy and L. Pierot and A.A. Rabinstein and Y.B.W.E.M. Roos and J. Rinne and R.H. Rosenwasser and A. Ronkainen and K. Schaller and V. Seifert and R.A. Solomon and J. Spears and H.J. Steiger and M.D.I. Vergouwen and I. Wanke and M.J.H. Wermer and G.K.C. Wong and J.H. Wong and G.J. Zipfel and {Sander Connolly}, E. and H. Steinmetz and G. Lanzino and A. Pasqualin and D. R{\"u}fenacht and P. Vajkoczy and C. Mcdougall and D. H{\"a}nggi and P. Leroux and G.J.E. Rinkel and {Loch Macdonald}, R.",

year = "2015",

month = sep,

day = "8",

doi = "10.1212/WNL.0000000000001891",

language = "English",

volume = "85",

pages = "881--889",

journal = "Neurology",

issn = "0028-3878",

publisher = "Lippincott Williams & Wilkins",

number = "10",

}

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, Salman, RAS, 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, HJ, Vergouwen, MDI, Wanke, I, Wermer, MJH, Wong, GKC, Wong, JH, Zipfel, GJ, Sander Connolly, E, Steinmetz, H, Lanzino, G, Pasqualin, A, Rüfenacht, D, Vajkoczy, P, Mcdougall, C, Hänggi, D, Leroux, P, Rinkel, GJE & Loch Macdonald, R 2015, 'The unruptured intracranial aneurysm treatment score: A multidis ciplinary consensus', Neurology, vol. 85, no. 10, pp. 881-889. https://doi.org/10.1212/WNL.0000000000001891, https://doi.org/10.1212/WNL.0000000000001891

TY - JOUR

T1 - The unruptured intracranial aneurysm treatment score: A multidis ciplinary consensus

AU - Etminan, N.

AU - Brown, R.D.

AU - Beseoglu, K.

AU - Juvela, S.

AU - Raymond, J.

AU - Morita, A.

AU - Torner, J.C.

AU - Derdeyn, C.P.

AU - Raabe, A.

AU - Mocco, J.

AU - Korja, M.

AU - Abdulazim, A.

AU - Amin-Hanjani, S.

AU - Salman, R.A.S.

AU - Barrow, D.L.

AU - Bederson, J.

AU - Bonafe, A.

AU - Dumont, A.S.

AU - Fiorella, D.J.

AU - Gruber, A.

AU - Hankey, Graeme J.

AU - Hasan, D.M.

AU - Hoh, B.L.

AU - Jabbour, P.

AU - Kasuya, H.

AU - Kelly, M.E.

AU - Kirkpatrick, P.J.

AU - Knuckey, N.

AU - Koivisto, T.

AU - Krings, T.

AU - Lawton, M.T.

AU - Marotta, T.R.

AU - Mayer, S.A.

AU - Mee, E.

AU - Pereira, V.M.

AU - Molyneux, A.

AU - Morgan, M.K.

AU - Mori, K.

AU - Murayama, Y.

AU - Nagahiro, S.

AU - Nakayama, N.

AU - Niemelä, M.

AU - Ogilvy, C.S.

AU - Pierot, L.

AU - Rabinstein, A.A.

AU - Roos, Y.B.W.E.M.

AU - Rinne, J.

AU - Rosenwasser, R.H.

AU - Ronkainen, A.

AU - Schaller, K.

AU - Seifert, V.

AU - Solomon, R.A.

AU - Spears, J.

AU - Steiger, H.J.

AU - Vergouwen, M.D.I.

AU - Wanke, I.

AU - Wermer, M.J.H.

AU - Wong, G.K.C.

AU - Wong, J.H.

AU - Zipfel, G.J.

AU - Sander Connolly, E.

AU - Steinmetz, H.

AU - Lanzino, G.

AU - Pasqualin, A.

AU - Rüfenacht, D.

AU - Vajkoczy, P.

AU - Mcdougall, C.

AU - Hänggi, D.

AU - Leroux, P.

AU - Rinkel, G.J.E.

AU - Loch Macdonald, R.

PY - 2015/9/8

Y1 - 2015/9/8

N2 - 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 (v(r)*) (v(r)* 5 0 indicating excellent agreement and v(r)* = 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 (v(r)*) 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.

AB - 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 (v(r)*) (v(r)* 5 0 indicating excellent agreement and v(r)* = 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 (v(r)*) 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.

KW - TERM-FOLLOW-UP

KW - NATURAL-HISTORY

KW - ENDOVASCULAR TREATMENT

KW - SACCULAR ANEURYSMS

KW - SURGICAL-TREATMENT

KW - RUPTURE RISK

KW - METAANALYSIS

KW - COHORT

KW - AGE

KW - MANAGEMENT

U2 - 10.1212/WNL.0000000000001891

DO - 10.1212/WNL.0000000000001891

M3 - Article

C2 - 26276380

SN - 0028-3878

VL - 85

SP - 881

EP - 889

JO - Neurology

JF - Neurology

IS - 10

ER -

The unruptured intracranial aneurysm treatment score: A multidis ciplinary consensus

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