The unruptured intracranial aneurysm treatment score: A multidis ciplinary consensus

Nima Etminan*, Robert D. Brown, Kerim Beseoglu, Seppo Juvela, Jean Raymond, Akio Morita, James C. Torner, Colin P. Derdeyn, Andreas Raabe, J. Mocco, Miikka Korja, Amr Abdulazim, Sepideh Amin-Hanjani, Rustam Al Shahi Salman, Daniel L. Barrow, Joshua Bederson, Alain Bonafe, Aaron S. Dumont, David J. Fiorella, Andreas GruberGraeme J. Hankey, David M. Hasan, Brian L. Hoh, Pascal Jabbour, Hidetoshi Kasuya, Michael E. Kelly, Peter J. Kirkpatrick, Neville Knuckey, Timo Koivisto, Timo Krings, Michael T. Lawton, Thomas R. Marotta, Stephan A. Mayer, Edward Mee, Vitor Mendes Pereira, Andrew Molyneux, Michael K. Morgan, Kentaro Mori, Yuichi Murayama, Shinji Nagahiro, Naoki Nakayama, Mika Niemelä, Christopher S. Ogilvy, Laurent Pierot, Alejandro A. Rabinstein, Yvo B.W.E.M. Roos, Jaakko Rinne, Robert H. Rosenwasser, Antti Ronkainen, Karl Schaller, Volker Seifert, Robert A. Solomon, Julian Spears, Hans Jakob Steiger, Mervyn D.I. Vergouwen, Isabel Wanke, Marieke J.H. Wermer, George K.C. Wong, John H. Wong, Gregory J. Zipfel, E. Sander Connolly, Helmuth Steinmetz, Giuseppe Lanzino, Alberto Pasqualin, Daniel Rüfenacht, Peter Vajkoczy, Cameron McDougall, Daniel Hänggi, Peter Leroux, Gabriel J.E. Rinkel, R. Loch Macdonald

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    296 Citations (Scopus)
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    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 (v r ) (v r 0 indicating excellent agreement and v r 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 (v r ) 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.

    Original languageEnglish
    Pages (from-to)881-889
    Number of pages9
    Issue number10
    Publication statusPublished - 8 Sept 2015

    Bibliographical note

    Copyright the American Academy of Neurology 2015. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


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