Confidence of treatment decision and perceived risk of procedure-related neurological complications in the management of unruptured intracranial aneurysms.
Adult
Aged
Angiography, Digital Subtraction
Clinical Decision-Making
Female
Humans
Intracranial Aneurysm
/ complications
Male
Middle Aged
Nervous System Diseases
/ diagnostic imaging
Neurosurgical Procedures
/ adverse effects
Postoperative Complications
/ therapy
Radiology, Interventional
Risk Assessment
Stents
Treatment Outcome
aneurysm
coil
flow diverter
intervention
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
received:
15
08
2018
revised:
19
10
2018
accepted:
20
10
2018
pubmed:
6
12
2018
medline:
18
6
2019
entrez:
6
12
2018
Statut:
ppublish
Résumé
To evaluate factors influencing the confidence of management recommendation for unruptured intracranial aneurysms (UIAs) and to assess the ability of neurointerventionalists to predict procedure-related neurological complications compared with a 3-point risk score. Twenty-eight neurointerventionalists were asked to evaluate digital subtraction angiographies examinations of patients with UIAs by determining the best management approach, their level of confidence in their management recommendation, and estimating the risk of procedure-related neurological complications. Knowledge and experience in interventional neuroradiology (INR) of each participant were assessed. Reliability was moderate regarding any treatment recommendation (ICC=0.49) and low regarding the estimation of risk of complications (ICC=0.38). The recommendation of clipping was less likely with more experience in INR (OR=0.6) and more likely with increasing knowledge (OR=1.7). Odds of recommending WEB device were lower with more experience in INR (OR=0.6), higher in patients with multiple aneurysms (OR=3.6) and increasing neck width (OR=2.7). The recommendation of stent-assisted coiling was more likely with increasing neck width (OR=2.4) and when cerebral ischemic comorbidities were present (OR=2.9). The participants were significantly worse than the risk score (mean area under the curve of 0.53) and not better than random guess in predicting complications. Neither knowledge nor experience in INR was significantly associated with the participants' ability to predict neurological complications. Our study shows a moderate interrater reliability of treatment recommendations of UIAs. Confidence in treatment recommendation varied significantly according to recommended treatments. Overall performance in predicting neurological complications was worse than the risk score and not better than random guess.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
To evaluate factors influencing the confidence of management recommendation for unruptured intracranial aneurysms (UIAs) and to assess the ability of neurointerventionalists to predict procedure-related neurological complications compared with a 3-point risk score.
MATERIALS AND METHODS
METHODS
Twenty-eight neurointerventionalists were asked to evaluate digital subtraction angiographies examinations of patients with UIAs by determining the best management approach, their level of confidence in their management recommendation, and estimating the risk of procedure-related neurological complications. Knowledge and experience in interventional neuroradiology (INR) of each participant were assessed.
RESULTS
RESULTS
Reliability was moderate regarding any treatment recommendation (ICC=0.49) and low regarding the estimation of risk of complications (ICC=0.38). The recommendation of clipping was less likely with more experience in INR (OR=0.6) and more likely with increasing knowledge (OR=1.7). Odds of recommending WEB device were lower with more experience in INR (OR=0.6), higher in patients with multiple aneurysms (OR=3.6) and increasing neck width (OR=2.7). The recommendation of stent-assisted coiling was more likely with increasing neck width (OR=2.4) and when cerebral ischemic comorbidities were present (OR=2.9). The participants were significantly worse than the risk score (mean area under the curve of 0.53) and not better than random guess in predicting complications. Neither knowledge nor experience in INR was significantly associated with the participants' ability to predict neurological complications.
CONCLUSIONS
CONCLUSIONS
Our study shows a moderate interrater reliability of treatment recommendations of UIAs. Confidence in treatment recommendation varied significantly according to recommended treatments. Overall performance in predicting neurological complications was worse than the risk score and not better than random guess.
Identifiants
pubmed: 30514734
pii: neurintsurg-2018-014346
doi: 10.1136/neurintsurg-2018-014346
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
479-484Informations de copyright
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.