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Management of unruptured intracranial aneurysms: correlation of UIATS, ELAPSS, and PHASES with referral center practice.
- Source :
-
Neurosurgical review [Neurosurg Rev] 2021 Jun; Vol. 44 (3), pp. 1625-1633. Date of Electronic Publication: 2020 Jul 22. - Publication Year :
- 2021
-
Abstract
- Concordance between the Unruptured Intracranial Aneurysm Treatment Score (UIATS), Earlier Subarachnoid Hemorrhage, Location, Age, Population, Size, Shape (ELAPSS) score, and Population, Hypertension, Age, Size, Earlier Subarachnoid Hemorrhage, Site (PHASES) score with real-world management decisions in unruptured intracranial aneurysms (UIAs) remains unclear, especially in current practice. This study aimed to investigate this concordance, while developing an optimal model predictive of recent decision practices at a quaternary referral center. A prospective database of patients presenting with UIAs to our institution from January 1 to December 31, 2018, was used. Concordance between the scores and real-world management decisions on every UIA was assessed. Complications and length of stay (LOS) were compared between aneurysms in the UIATS-recommended treatment and observation groups. A subgroup analysis of concordance was also conducted among junior and senior surgeons. An optimal logistic regression model predictive of real-world decisions was also derived. The cohort consisted of 198 patients with 271 UIAs, of which 42% were treated. The UIATS demonstrated good concordance with an AUC of 0.765. Of the aneurysms in the UIATS-recommended "observation" group, 22% were discordantly treated. The ELAPSS score demonstrated good discrimination (AUC = 0.793), unlike the PHASES score (AUC = 0.579). Endovascular treatment rates, complications, and LOS were similar between aneurysms in the UIATS-recommended treatment and observation groups. Similar concordance was obtained among junior and senior surgeons. The optimal predictive model consisted of several significantly associated variables and had an AUC of 0.942. Cerebrovascular specialists may be treating aneurysms slightly more than these scores would recommend, independently of years in practice. Wide variation still exists in management practices of UIAs.
- Subjects :
- Adult
Aged
Cohort Studies
Female
Humans
Hypertension diagnostic imaging
Hypertension surgery
Intracranial Aneurysm diagnostic imaging
Male
Middle Aged
Prospective Studies
Referral and Consultation trends
Subarachnoid Hemorrhage diagnostic imaging
Subarachnoid Hemorrhage surgery
Disease Management
Endovascular Procedures methods
Intracranial Aneurysm surgery
Neurosurgical Procedures methods
Tertiary Care Centers trends
Subjects
Details
- Language :
- English
- ISSN :
- 1437-2320
- Volume :
- 44
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Neurosurgical review
- Publication Type :
- Academic Journal
- Accession number :
- 32700160
- Full Text :
- https://doi.org/10.1007/s10143-020-01356-6