Current decision support tools fail to agree or predict therapeutic decisions in a single cohort of unruptured intracranial aneurysms

• DOI: 10.1007/s00701-021-04852-w
• Publication Date: 2021-05-06T15:02:35Z
• Authors: Ahilan Kailaya-Vasan; Joseph Frantzias; Jayantan Kailaya-...; Ian A. Anderson; Daniel C. Walsh
• Keywords: Neurovascular bundle; Neuroradiology; Interventional radiology

There is limited evidence to direct the management of unruptured intracranial aneurysms. Models extrapolated from existing data have been proposed guide treatment recommendations. The aim this study assess whether a consensus-based score (UIATS) or rupture rate estimation model (PHASES) can be used benchmark UK multi-disciplinary team (MDT) practice.Prospective was collected on consecutive series all patients with aneurysms (UIAs) presenting major neurovascular centre between 2012 and 2015. agreement UIATS PHASES scores, their sensitivity specificity in predicting real-world MDT outcome were calculated compared.A total 366 (456 aneurysms) included analysis. recommendation low (weighted kappa 0.26 [95% CI 0.19, 0.32]); also at 36% 52% respectively. Groups that allocated treatment, equipoise no had significantly different scores (p = 0.004). significant difference two when for whom recommend aneurysm but superior who received an 'treatment-equipoise', 'not-for-treatment' (AUC 0.73 compared 0.59 PHASES).The models studied failed agree consensus view centre. We conclude decision support tools such as should not blindly introduced respective institutions without prior internal validation, they may represent local reality.