The unruptured intracranial aneurysm treatment score: A multidis ciplinary consensus

Nima Etminan, Robert D Jr. Brown, Kerim Beseoglu, Seppo Juvela, Jean Raymond, Akio Morita, James C. Torner, Colin P. Derdeyn, Andreas Raabe, J. Mocco, Miikka Korja, Amr Abdulazim, Sepideh Amin-Hanjani, Rustam Al Shahi Salman, Daniel L. Barrow, Joshua Bederson, Alain Bonafe, Aaron S. Dumont, David J. Fiorella, Andreas GruberGraeme J. Hankey, David M. Hasan, Brian L. Hoh, Pascal Jabbour, Hidetoshi Kasuya, Michael E. Kelly, Peter J. Kirkpatrick, Neville Knuckey, Timo Koivisto, Timo Krings, Michael T. Lawton, Thomas R. Marotta, Stephan A. Mayer, Edward Mee, Vitor Mendes Pereira, Andrew Molyneux, Michael K. Morgan, Kentaro Mori, Yuichi Murayama, Shinji Nagahiro, Naoki Nakayama, Mika Niemelä, Christopher S. Ogilvy, Laurent Pierot, Alejandro Rabinstein, Yvo B W E M Roos, Jaakko Rinne, Robert H. Rosenwasser, Antti Ronkainen, Karl Schaller, Volker Seifert, Robert A. Solomon, Julian Spears, Hans Jakob Steiger, Mervyn D I Vergouwen, Isabel Wanke, Marieke J H Wermer, George K C Wong, John H. Wong, Gregory J. Zipfel, E. Sander Connolly, Helmuth Steinmetz, Giuseppe Lanzino, Alberto Pasqualin, Daniel Rüfenacht, Peter Vajkoczy, Cameron McDougall, Daniel Hänggi, Peter Leroux, Gabriel J E Rinkel, R. Loch Macdonald

Research output: Contribution to journalArticle

105 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 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 languageEnglish (US)
Pages (from-to)881-889
Number of pages9
JournalNeurology
Volume85
Issue number10
DOIs
StatePublished - Sep 8 2015

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Intracranial Aneurysm
Confidence Intervals
Neurosurgery
Neurology
Epidemiology
Research

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Etminan, N., Brown, R. D. J., Beseoglu, K., Juvela, S., Raymond, J., Morita, A., ... 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

The unruptured intracranial aneurysm treatment score : A multidis ciplinary consensus. / Etminan, Nima; Brown, Robert D Jr.; 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; Salman, Rustam Al Shahi; Barrow, Daniel L.; Bederson, Joshua; Bonafe, Alain; Dumont, Aaron S.; Fiorella, David J.; Gruber, Andreas; Hankey, Graeme J.; Hasan, David M.; Hoh, Brian L.; Jabbour, Pascal; Kasuya, Hidetoshi; Kelly, Michael E.; Kirkpatrick, Peter J.; Knuckey, Neville; Koivisto, Timo; Krings, Timo; Lawton, Michael T.; Marotta, Thomas R.; Mayer, Stephan A.; Mee, Edward; Pereira, Vitor Mendes; Molyneux, Andrew; Morgan, Michael K.; Mori, Kentaro; Murayama, Yuichi; Nagahiro, Shinji; Nakayama, Naoki; Niemelä, Mika; Ogilvy, Christopher S.; Pierot, Laurent; Rabinstein, Alejandro; Roos, Yvo B W E M; Rinne, Jaakko; Rosenwasser, Robert H.; Ronkainen, Antti; Schaller, Karl; Seifert, Volker; Solomon, Robert A.; Spears, Julian; Steiger, Hans Jakob; Vergouwen, Mervyn D I; Wanke, Isabel; Wermer, Marieke J H; Wong, George K C; Wong, John H.; Zipfel, Gregory J.; Sander Connolly, E.; Steinmetz, Helmuth; Lanzino, Giuseppe; Pasqualin, Alberto; Rüfenacht, Daniel; Vajkoczy, Peter; McDougall, Cameron; Hänggi, Daniel; Leroux, Peter; Rinkel, Gabriel J E; Loch Macdonald, R.

In: Neurology, Vol. 85, No. 10, 08.09.2015, p. 881-889.

Research output: Contribution to journalArticle

Etminan, N, Brown, RDJ, 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, A, 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
Etminan, Nima ; Brown, Robert D Jr. ; 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 ; Salman, Rustam Al Shahi ; Barrow, Daniel L. ; Bederson, Joshua ; Bonafe, Alain ; Dumont, Aaron S. ; Fiorella, David J. ; Gruber, Andreas ; Hankey, Graeme J. ; Hasan, David M. ; Hoh, Brian L. ; Jabbour, Pascal ; Kasuya, Hidetoshi ; Kelly, Michael E. ; Kirkpatrick, Peter J. ; Knuckey, Neville ; Koivisto, Timo ; Krings, Timo ; Lawton, Michael T. ; Marotta, Thomas R. ; Mayer, Stephan A. ; Mee, Edward ; Pereira, Vitor Mendes ; Molyneux, Andrew ; Morgan, Michael K. ; Mori, Kentaro ; Murayama, Yuichi ; Nagahiro, Shinji ; Nakayama, Naoki ; Niemelä, Mika ; Ogilvy, Christopher S. ; Pierot, Laurent ; Rabinstein, Alejandro ; Roos, Yvo B W E M ; Rinne, Jaakko ; Rosenwasser, Robert H. ; Ronkainen, Antti ; Schaller, Karl ; Seifert, Volker ; Solomon, Robert A. ; Spears, Julian ; Steiger, Hans Jakob ; Vergouwen, Mervyn D I ; Wanke, Isabel ; Wermer, Marieke J H ; Wong, George K C ; Wong, John H. ; Zipfel, Gregory J. ; Sander Connolly, E. ; Steinmetz, Helmuth ; Lanzino, Giuseppe ; Pasqualin, Alberto ; Rüfenacht, Daniel ; Vajkoczy, Peter ; McDougall, Cameron ; Hänggi, Daniel ; Leroux, Peter ; Rinkel, Gabriel J E ; Loch Macdonald, R. / The unruptured intracranial aneurysm treatment score : A multidis ciplinary consensus. In: Neurology. 2015 ; Vol. 85, No. 10. pp. 881-889.
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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 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.",
author = "Nima Etminan and Brown, {Robert D Jr.} and Kerim Beseoglu and Seppo Juvela and Jean Raymond and Akio Morita and Torner, {James C.} and Derdeyn, {Colin P.} and Andreas Raabe and J. Mocco and Miikka Korja and Amr Abdulazim and Sepideh Amin-Hanjani and Salman, {Rustam Al Shahi} and Barrow, {Daniel L.} and Joshua Bederson and Alain Bonafe and Dumont, {Aaron S.} and Fiorella, {David J.} and Andreas Gruber and Hankey, {Graeme J.} and Hasan, {David M.} and Hoh, {Brian L.} and Pascal Jabbour and Hidetoshi Kasuya and Kelly, {Michael E.} and Kirkpatrick, {Peter J.} and Neville Knuckey and Timo Koivisto and Timo Krings and Lawton, {Michael T.} and Marotta, {Thomas R.} and Mayer, {Stephan A.} and Edward Mee and Pereira, {Vitor Mendes} and Andrew Molyneux and Morgan, {Michael K.} and Kentaro Mori and Yuichi Murayama and Shinji Nagahiro and Naoki Nakayama and Mika Niemel{\"a} and Ogilvy, {Christopher S.} and Laurent Pierot and Alejandro Rabinstein and Roos, {Yvo B W E M} and Jaakko Rinne and Rosenwasser, {Robert H.} and Antti Ronkainen and Karl Schaller and Volker Seifert and Solomon, {Robert A.} and Julian Spears and Steiger, {Hans Jakob} and Vergouwen, {Mervyn D I} and Isabel Wanke and Wermer, {Marieke J H} and Wong, {George K C} and Wong, {John H.} and Zipfel, {Gregory J.} and {Sander Connolly}, E. and Helmuth Steinmetz and Giuseppe Lanzino and Alberto Pasqualin and Daniel R{\"u}fenacht and Peter Vajkoczy and Cameron McDougall and Daniel H{\"a}nggi and Peter Leroux and Rinkel, {Gabriel J E} and {Loch Macdonald}, R.",
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month = "9",
day = "8",
doi = "10.1212/WNL.0000000000001891",
language = "English (US)",
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pages = "881--889",
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TY - JOUR

T1 - The unruptured intracranial aneurysm treatment score

T2 - A multidis ciplinary consensus

AU - Etminan, Nima

AU - Brown, Robert D Jr.

AU - Beseoglu, Kerim

AU - Juvela, Seppo

AU - Raymond, Jean

AU - Morita, Akio

AU - Torner, James C.

AU - Derdeyn, Colin P.

AU - Raabe, Andreas

AU - Mocco, J.

AU - Korja, Miikka

AU - Abdulazim, Amr

AU - Amin-Hanjani, Sepideh

AU - Salman, Rustam Al Shahi

AU - Barrow, Daniel L.

AU - Bederson, Joshua

AU - Bonafe, Alain

AU - Dumont, Aaron S.

AU - Fiorella, David J.

AU - Gruber, Andreas

AU - Hankey, Graeme J.

AU - Hasan, David M.

AU - Hoh, Brian L.

AU - Jabbour, Pascal

AU - Kasuya, Hidetoshi

AU - Kelly, Michael E.

AU - Kirkpatrick, Peter J.

AU - Knuckey, Neville

AU - Koivisto, Timo

AU - Krings, Timo

AU - Lawton, Michael T.

AU - Marotta, Thomas R.

AU - Mayer, Stephan A.

AU - Mee, Edward

AU - Pereira, Vitor Mendes

AU - Molyneux, Andrew

AU - Morgan, Michael K.

AU - Mori, Kentaro

AU - Murayama, Yuichi

AU - Nagahiro, Shinji

AU - Nakayama, Naoki

AU - Niemelä, Mika

AU - Ogilvy, Christopher S.

AU - Pierot, Laurent

AU - Rabinstein, Alejandro

AU - Roos, Yvo B W E M

AU - Rinne, Jaakko

AU - Rosenwasser, Robert H.

AU - Ronkainen, Antti

AU - Schaller, Karl

AU - Seifert, Volker

AU - Solomon, Robert A.

AU - Spears, Julian

AU - Steiger, Hans Jakob

AU - Vergouwen, Mervyn D I

AU - Wanke, Isabel

AU - Wermer, Marieke J H

AU - Wong, George K C

AU - Wong, John H.

AU - Zipfel, Gregory J.

AU - Sander Connolly, E.

AU - Steinmetz, Helmuth

AU - Lanzino, Giuseppe

AU - Pasqualin, Alberto

AU - Rüfenacht, Daniel

AU - Vajkoczy, Peter

AU - McDougall, Cameron

AU - Hänggi, Daniel

AU - Leroux, Peter

AU - Rinkel, Gabriel 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 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 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.

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