The unruptured intracranial aneurysm treatment score: a multidisciplinary consensus.
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 (vr*) (vr* = 0 indicating excellent agreement and vr* = 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 (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.
Author affiliations are provided at the end of the article. etminan@uni-duesseldorf.de.
Nima
N
Etminan
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Robert D
RD
Brown
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Kerim
K
Beseoglu
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Seppo
S
Juvela
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Jean
J
Raymond
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Akio
A
Morita
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James C
JC
Torner
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Colin P
CP
Derdeyn
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Andreas
A
Raabe
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J
J
Mocco
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Miikka
M
Korja
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Amr
A
Abdulazim
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Sepideh
S
Amin-Hanjani
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Rustam
R
Al-Shahi Salman
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Daniel L
DL
Barrow
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Joshua
J
Bederson
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Alain
A
Bonafe
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Aaron S
AS
Dumont
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David J
DJ
Fiorella
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Andreas
A
Gruber
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Graeme J
GJ
Hankey
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David M
DM
Hasan
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Brian L
BL
Hoh
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Pascal
P
Jabbour
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Hidetoshi
H
Kasuya
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Michael E
ME
Kelly
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Peter J
PJ
Kirkpatrick
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Neville
N
Knuckey
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Timo
T
Koivisto
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Timo
T
Krings
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Michael T
MT
Lawton
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Thomas R
TR
Marotta
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Stephan A
SA
Mayer
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Edward
E
Mee
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Vitor Mendes
VM
Pereira
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Andrew
A
Molyneux
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Michael K
MK
Morgan
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Kentaro
K
Mori
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Yuichi
Y
Murayama
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Shinji
S
Nagahiro
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Naoki
N
Nakayama
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Mika
M
Niemelä
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Christopher S
CS
Ogilvy
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Laurent
L
Pierot
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Alejandro A
AA
Rabinstein
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Yvo B W E M
YB
Roos
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Jaakko
J
Rinne
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Robert H
RH
Rosenwasser
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Antti
A
Ronkainen
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Karl
K
Schaller
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Volker
V
Seifert
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Robert A
RA
Solomon
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Julian
J
Spears
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Hans-Jakob
HJ
Steiger
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Mervyn D I
MD
Vergouwen
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Isabel
I
Wanke
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Marieke J H
MJ
Wermer
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George K C
GK
Wong
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John H
JH
Wong
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Gregory J
GJ
Zipfel
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E Sander
ES
Connolly
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Helmuth
H
Steinmetz
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Giuseppe
G
Lanzino
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Alberto
A
Pasqualin
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Daniel
D
Rüfenacht
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Peter
P
Vajkoczy
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Cameron
C
McDougall
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Daniel
D
Hänggi
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Peter
P
LeRoux
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Gabriel J E
GJ
Rinkel
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R Loch
RL
Macdonald
D006801:Humans; D038622:Internationality; D007400:Interprofessional Relations; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D010348:Patient Care Team / Q000592:standards*; D012720:Severity of Illness Index; D016896:Treatment Outcome