Neurology 85(3):881-889 2015
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 involvedin identification of relevant features) and external validation (30 independent external reviewers), 30 selected UIA cases were used to analyze agree-ment 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*5 0 indicating excellent agreement and vr*5 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 (p5 0.017). Mean Likert scores were 4.2 (95% CI 4.1–4.3) for interventional reviewers (n5 56) and 4.1 (95% CI 3.9–4.4) for noninterventional reviewers (n5 12) (p5 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.
You must be logged in to post a comment.