Management of incidental aneurysms: comparison of single Centre multi-disciplinary team decision making with the unruptured incidental aneurysm treatment score

British Journal of Neurosurgery
Alex SmedleyJoan P Grieve

Abstract

To compare multidisciplinary team (MDT) decision making at our centre with the suggested management from the recently published Unruptured Intracranial Aneurysm Treatment Score (UIATS), with particular focus on disagreements between the two bodies of expert opinion. A retrospective audit of local practice. Adult patients with incidental cerebral saccular aneurysms referred to The National Hospital for Neurology and Neurosurgery Neurovascular MDT. Review of MDT records from 2010-2015 and collection of UIATS criteria. MDT decisions for each aneurysm were designated as conservative or treatment group, then assessed for correlation with the UIATS. Data was collected on 398 aneurysms from 296 patients. 57% of aneurysms were managed conservatively and 43% were treated with endovascular or open repair. Total follow up was 8409 aneurysm months (mean: 21 months per aneurysm). The overall proportion of agreement (p0) was 66.6% (95% CI: 61.9-71.2). Cohen's Kappa (k) was 0.325 suggesting only a "fair" level of agreement between the two raters. Absolute agreement rates increased from 60% in 2010 to 74% in 2015. Aneurysm size was an important factor for disagreement, 77% of aneurysms treated following MDT, but not in agreement with the UIATS...Continue Reading

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Citations

Jul 28, 2020·Neurosurgical Review·Vittorio Stumpo, Carmelo Lucio Sturiale
Nov 12, 2020·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·Rob MolenbergJ Marc C van Dijk
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Jan 1, 2022·Journal of Neurosurgery·Andrew S Little, Sherry J Wu

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