P.051 Validation of the unruptured intracranial aneurysm treatment score against "real-world" MDT decisions. (2nd June 2017)

• Record Type: Journal Article
• Authors: Godbout, H; Jarrett, J; Pickett, GE
• Is Part Of: Canadian journal of neurological sciences. Volume 44(2017)Supplement 2
• Page Start: S26
• Page End: S26
• Publication Date: 2017-06-02
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Electronic journals; 616.8
• DOI: 10.1017/cjn.2017.136
• Languages: English
• ISSNs: 0317-1671

Abstract

Abstract : Background: Intracranial aneurysms are relatively common and often incidentally detected. Elective treatment may eliminate the risk of future hemorrhage, but carries risks of permanent deficit or death. Case-control studies have suggested factors predisposing to aneurysm rupture as well as risks of elective aneurysm repair. A clinical tool was recently developed to weigh benefits of repair against treatment risks. We evaluate its performance against real-world clinical decisions made by a cerebrovascular multidisciplinary team (MDT).Methods: Chart review of all patients with unruptured intracranial berry aneurysms (UIA) discussed at cerebrovascular MDT rounds 2008-2015. Management decisions and clinical outcomes were recorded. The Unruptured Intracranial Aneurysm Treatment Score (UIATS) was calculated for each patient (each aneurysm in the case of multiple UIA).Results: We identified 240 patients with a total of 279 aneurysms. UIATS recommended aneurysm repair in 79 cases, conservative management in 88 cases, and was equivocal in 112 cases. Where the UIATS gave a clear decision, that decision was concordant with the MDT decision in 119/167 cases (71%). Discordant decisions often related to the presence of comorbidities. Clinical outcomes did not differ in cases where the recommendations were clearly concordant vs. discordant.Conclusions: The UIATS may provide guidance to non-expert clinicians. It did not outperform the MDT.