Confidence of treatment decision and perceived risk of procedure-related neurological complications in the management of unruptured intracranial aneurysms
| Autor: | Levente Kriston, Marielle Ernst, Andreas Frölich, Jens Fiehler, Uta Hanning, J. H. Buhk |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Clinical Decision-Making Radiology Interventional Risk Assessment Neurosurgical Procedures 030218 nuclear medicine & medical imaging Odds 03 medical and health sciences Postoperative Complications 0302 clinical medicine Aneurysm Humans Medicine Interventional neuroradiology Aged Clipping (audio) Framingham Risk Score business.industry Angiography Digital Subtraction Intracranial Aneurysm General Medicine Middle Aged medicine.disease Confidence interval Risk perception Inter-rater reliability Treatment Outcome Emergency medicine Female Stents Surgery Neurology (clinical) Nervous System Diseases business 030217 neurology & neurosurgery |
| Zdroj: | Journal of NeuroInterventional Surgery. 11:479-484 |
| ISSN: | 1759-8486 1759-8478 |
| Popis: | Background and purposeTo 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 methodsTwenty-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.ResultsReliability 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.ConclusionsOur 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. |
| Databáze: | OpenAIRE |
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