Artikel
The unruptured intracranial aneurysm treatment score (UAITS) – Proposal from a multidisciplinary expert group
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Autoren
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Nima Etminan
- Neurochirurgische Klinik, Heinrich-Heine Universität, Düsseldorf
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Kerim Beseoglu
- Neurochirurgische Klinik, Heinrich-Heine Universität, Düsseldorf
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R. Loch Macdonald
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto Toronto, Canada
| Veröffentlicht: | 21. Mai 2013 |
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Gliederung
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Objective: The natural history of unruptured intracranial aneurysms and their treatment is controversial, yet these lesions are identified more frequently as more people undergo brain imaging for nonspecific symptoms and are found to have incidental, unruptured intracranial aneurysms (UIA). We aimed to develop an unruptured intracranial aneurysm treatment score (UIATS) based on a multidisciplinary, expert opinion derived Delphi consensus approach to guide decision making about UIA treatment.
Method: An international, multidisciplinary panel of experts (Neurology, Neurosurgery and Neuroradiology) involved in research, diagnosis and treatment of cerebral aneurysms was formed. Thereafter, a 4-step, survey-based Delphi consensus process was initiated to: a) identify and b) rate all features thought relevant to asses the risk of rupture and treatment of UIAs to create the UIATS system. In round 2, panel members were asked to rate each individual feature named in Round 1 using a 0-10 ranking scale or 0-100% for treatment risks, so that statistical weight can be determined using mean values for each factor. This step will be repeated in Round 3 to exclude a significant discrepancy. In the final round, different cases of patients with UIAs and corresponding recommendations based on the developed UIATS system will be presented to the panel to test the level of acceptance using a 5-point Likert scale. Kappa
Results: Thirty-nine out of 40 contacted experts, from 12 different countries and 4 continents, agreed to participate. To date, a minimum 85% of the panel participated in round 1 and 2. More than 60 aneurysm-, patient or treatment-related features were named by the panel to be relevant to assess or treat an UIA in round 1. Each of these factors was rated subsequently in rounds 2 and 3 to determine its statistical relevance, and so its importance to evaluate an UIA.
Conclusions: We aim to finalize the UIATS system by January 2013. Ultimately, this scoring system, derived from a consensus among a large, international, multidisciplinary group, may aid clinicians decide about the expected natural history and treatment risk of an UIA.
