Comparing outcome scales for unruptured intracranial aneurysms: a prospective cohort study

Michael K. Morgan, Joan M. O'Donnell, Gillian Z. Heller, Jeffrey M. Rogers

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Outcomes on the modified Rankin Scale (mRS) are commonly used to guide and evaluate the management of unruptured intracranial aneurysms (uIA). However, the mRS is unlikely to measure all the relevant aspects of the clinical health of a patient. The current study therefore investigated the relationship between the mRS and additional measures of outcome. Between January 2011 and January 2016 patients with a new diagnosis of uIA were prospectively examined at referral and 12-month follow-up. Assessment included the Physical and Mental Component Scores of the Short Form 36 (SF-36), the computerized driver screening instrument DriveSafe (DS), and the mRS. Minimally Important Change (MIC) for each outcome measure was used to identify adverse outcomes for individual patients. A total of 128 patients (98 surgery; 30 untreated) completed the minimal dataset for analysis. In the surgical group, 6% (95% CI 3–14%) experienced morbidity at 12-months, as defined by the MIC for mRS. This risk rate increased to 51% (95% CI 41–61%) when defined as an MIC on any outcome. A combined MIC also identified a downgrade in outcomes, not detectable on the mRS, in 42% (95% CI 26–61%) of untreated patients. Correlation and regression analyses were unable to identify any significant relationships between the different outcomes instruments. In sum, there were considerably more adverse outcomes reported by quality of life (SF-36) and functional (DS) instruments than by the mRS for either treated or untreated uIA. To obtain a more complete representation of patient outcomes requires administration of a multi-dimensional assessment.

LanguageEnglish
Pages56-63
Number of pages8
JournalJournal of Clinical Neuroscience
Volume58
DOIs
Publication statusPublished - Dec 2018

Fingerprint

Intracranial Aneurysm
Cohort Studies
Prospective Studies
Outcome Assessment (Health Care)
Referral and Consultation
Regression Analysis
Quality of Life
Morbidity
Health

Keywords

  • Disability evaluation
  • Intracranial aneurysm
  • Neurosurgical procedures
  • Outcome assessment
  • Quality of life

Cite this

Morgan, Michael K. ; O'Donnell, Joan M. ; Heller, Gillian Z. ; Rogers, Jeffrey M. / Comparing outcome scales for unruptured intracranial aneurysms : a prospective cohort study. In: Journal of Clinical Neuroscience. 2018 ; Vol. 58. pp. 56-63.
@article{1e9810c954b74ee5b0a2a66cda60ebde,
title = "Comparing outcome scales for unruptured intracranial aneurysms: a prospective cohort study",
abstract = "Outcomes on the modified Rankin Scale (mRS) are commonly used to guide and evaluate the management of unruptured intracranial aneurysms (uIA). However, the mRS is unlikely to measure all the relevant aspects of the clinical health of a patient. The current study therefore investigated the relationship between the mRS and additional measures of outcome. Between January 2011 and January 2016 patients with a new diagnosis of uIA were prospectively examined at referral and 12-month follow-up. Assessment included the Physical and Mental Component Scores of the Short Form 36 (SF-36), the computerized driver screening instrument DriveSafe (DS), and the mRS. Minimally Important Change (MIC) for each outcome measure was used to identify adverse outcomes for individual patients. A total of 128 patients (98 surgery; 30 untreated) completed the minimal dataset for analysis. In the surgical group, 6{\%} (95{\%} CI 3–14{\%}) experienced morbidity at 12-months, as defined by the MIC for mRS. This risk rate increased to 51{\%} (95{\%} CI 41–61{\%}) when defined as an MIC on any outcome. A combined MIC also identified a downgrade in outcomes, not detectable on the mRS, in 42{\%} (95{\%} CI 26–61{\%}) of untreated patients. Correlation and regression analyses were unable to identify any significant relationships between the different outcomes instruments. In sum, there were considerably more adverse outcomes reported by quality of life (SF-36) and functional (DS) instruments than by the mRS for either treated or untreated uIA. To obtain a more complete representation of patient outcomes requires administration of a multi-dimensional assessment.",
keywords = "Disability evaluation, Intracranial aneurysm, Neurosurgical procedures, Outcome assessment, Quality of life",
author = "Morgan, {Michael K.} and O'Donnell, {Joan M.} and Heller, {Gillian Z.} and Rogers, {Jeffrey M.}",
year = "2018",
month = "12",
doi = "10.1016/j.jocn.2018.10.064",
language = "English",
volume = "58",
pages = "56--63",
journal = "Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia",
issn = "0967-5868",
publisher = "Churchill Livingstone",

}

Comparing outcome scales for unruptured intracranial aneurysms : a prospective cohort study. / Morgan, Michael K.; O'Donnell, Joan M.; Heller, Gillian Z.; Rogers, Jeffrey M.

In: Journal of Clinical Neuroscience, Vol. 58, 12.2018, p. 56-63.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Comparing outcome scales for unruptured intracranial aneurysms

T2 - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

AU - Morgan, Michael K.

AU - O'Donnell, Joan M.

AU - Heller, Gillian Z.

AU - Rogers, Jeffrey M.

PY - 2018/12

Y1 - 2018/12

N2 - Outcomes on the modified Rankin Scale (mRS) are commonly used to guide and evaluate the management of unruptured intracranial aneurysms (uIA). However, the mRS is unlikely to measure all the relevant aspects of the clinical health of a patient. The current study therefore investigated the relationship between the mRS and additional measures of outcome. Between January 2011 and January 2016 patients with a new diagnosis of uIA were prospectively examined at referral and 12-month follow-up. Assessment included the Physical and Mental Component Scores of the Short Form 36 (SF-36), the computerized driver screening instrument DriveSafe (DS), and the mRS. Minimally Important Change (MIC) for each outcome measure was used to identify adverse outcomes for individual patients. A total of 128 patients (98 surgery; 30 untreated) completed the minimal dataset for analysis. In the surgical group, 6% (95% CI 3–14%) experienced morbidity at 12-months, as defined by the MIC for mRS. This risk rate increased to 51% (95% CI 41–61%) when defined as an MIC on any outcome. A combined MIC also identified a downgrade in outcomes, not detectable on the mRS, in 42% (95% CI 26–61%) of untreated patients. Correlation and regression analyses were unable to identify any significant relationships between the different outcomes instruments. In sum, there were considerably more adverse outcomes reported by quality of life (SF-36) and functional (DS) instruments than by the mRS for either treated or untreated uIA. To obtain a more complete representation of patient outcomes requires administration of a multi-dimensional assessment.

AB - Outcomes on the modified Rankin Scale (mRS) are commonly used to guide and evaluate the management of unruptured intracranial aneurysms (uIA). However, the mRS is unlikely to measure all the relevant aspects of the clinical health of a patient. The current study therefore investigated the relationship between the mRS and additional measures of outcome. Between January 2011 and January 2016 patients with a new diagnosis of uIA were prospectively examined at referral and 12-month follow-up. Assessment included the Physical and Mental Component Scores of the Short Form 36 (SF-36), the computerized driver screening instrument DriveSafe (DS), and the mRS. Minimally Important Change (MIC) for each outcome measure was used to identify adverse outcomes for individual patients. A total of 128 patients (98 surgery; 30 untreated) completed the minimal dataset for analysis. In the surgical group, 6% (95% CI 3–14%) experienced morbidity at 12-months, as defined by the MIC for mRS. This risk rate increased to 51% (95% CI 41–61%) when defined as an MIC on any outcome. A combined MIC also identified a downgrade in outcomes, not detectable on the mRS, in 42% (95% CI 26–61%) of untreated patients. Correlation and regression analyses were unable to identify any significant relationships between the different outcomes instruments. In sum, there were considerably more adverse outcomes reported by quality of life (SF-36) and functional (DS) instruments than by the mRS for either treated or untreated uIA. To obtain a more complete representation of patient outcomes requires administration of a multi-dimensional assessment.

KW - Disability evaluation

KW - Intracranial aneurysm

KW - Neurosurgical procedures

KW - Outcome assessment

KW - Quality of life

UR - http://www.scopus.com/inward/record.url?scp=85055144753&partnerID=8YFLogxK

U2 - 10.1016/j.jocn.2018.10.064

DO - 10.1016/j.jocn.2018.10.064

M3 - Article

VL - 58

SP - 56

EP - 63

JO - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

JF - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

SN - 0967-5868

ER -