Article
Is the unruptured intracranial aneurysm treatment score (UIATS) a sensitive enough tool to detect aneurysms at risk of rupture?
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Authors
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Silvia Hernández-Durán
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Dorothee Mielke
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Veit Rohde
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Vesna Malinova
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: The unruptured intracranial aneurysm treatment score (UIATS) was published in April 2015 as a multidisciplinary consensus among cerebrovascular specialists regarding treatment of unruptured intracranial aneurysms (UIA). The UIATS is based on the stratification of aneurysm-related, treatment-related, and patient-related risk factors. While it is thought to aid in clinical decision-making, the UIATS has only been scarcely validated for UIA. Furthermore, no studies have been conducted to evaluate whether or not the UIATS is a sensitive tool to detect aneurysms at risk of rupture.
Methods: We performed a retrospective analysis of adult patients admitted to our center from January 2010 to April 2016 with aneurysmal subarachnoid hemorrhage. Patients harboring infective, traumatic, fusiform, or dissecting aneurysms were excluded. The UIATS was applied to all ruptured aneurysms. Patients for whom the UIATS recommended treatment were labeled as “true positives”, whereas patients for whom the UIATS recommended observation were labeled as “false negatives”. Patients for whom the UIATS was inconclusive were excluded from the final analysis. Based on the UIATS recommendation, a sensitivity analysis was performed.
Results: A total of 262 patients with aneurysmal subarachnoid hemorrhage were screened. Of these, 111 patients with a complete data set were included in our analysis. Mean age was 56 years (23–88). Most patients were females (n=70, 63%) with high grade hemorrhages (Hunt & Hess ≥3 n=59, 53%, and Fisher ≥3 n=110, 99%). Most aneurysms were located in the anterior communicating artery (n=35, 32%). UIATS recommended treatment in n=52, 47% patients (true positives), was inconclusive in n=13, 12% (excluded), and recommended observation in n=46, 41%. Based on these data, the UIATS showed a sensitivity of 53.06% (CI 42.71 – 63.22%).
Conclusion: The UIATS exhibits rather low sensitivity for detecting aneurysms at risk of rupture. Unfortunately, no mathematical model currently exists to predict UIA rupture risk and/or treatment benefits. While helpful in guiding clinical decision-making, the UIATS remains only another equivocal tool in the armamentarium of the cerebrovascular neurosurgeon.
