Abstract 123: The Unruptured Intracranial Aneurysm Treatment Score (UAITS) - Proposal of a Multidisciplinary Research Group
Objective: Unruptured intracranial aneurysms (UIAs) are being identified with increasing frequency. Their natural history is being defined but their appropriate treatment remains controversial. We convened a panel of experts with the aim being the development of a treatment score (UIATS) that could guide decision making for treatment of UIAs.
Method: An international, multidisciplinary (Neurology, Clinical Epidemiology, Neurosurgery and Neuroradiology) panel of experts on research and treatment of cerebral aneurysms was formed. Panel members were chosen to be geographically and professionally dispersed, to increase the validity of the score. A 5-round, Delphi consensus process was initiated to identify and rate all features, relevant to assess UIAs and their treatment based on current evidence and practice. Rating scales and risk percentages were repeatedly used to determine statistical weight for each factor and to exclude significant discrepancies between rounds. Medians from all rounds were then transformed into corresponding scores for every item to create the scoring system. Representative cases of patients with UIAs were used to test decision-making and the level of acceptance as well to validate the score.
Results: A minimum of 85% of 39 experts, from 12 different countries participated in the first 4 rounds. More than 60 relevant features were initially listed by the panel. These items were subsequently rated repeatedly, until the least relevant items were omitted. The UIATS system was then created based on 13 highly relevant items. Despite some heterogeneity for individual ratings, there were no significant inconsistencies throughout the rounds. The system comprises different features of 3 main categories (patient-, aneurysm - and treatment-related factors), which all add up to one specific ratio. This ratio reflects the sum of factors supporting treatment or conservative management for UIAs, based on individual medical constellations.
Conclusion: Following internal and external validation, this scoring system, derived from a consensus among a large, international and multidisciplinary group of experts, may aid clinicians to decide about the expected natural history and treatment risk of an UIA.
Author Disclosures: N. Etminan: Consultant/Advisory Board; Modest; less than 10.000. K. Beseoglu: None. L. Macdonald: Consultant/Advisory Board; Significant; >10.000.
- © 2014 by American Heart Association, Inc.