Journal article
Decision-making and neurosurgeons' agreement in the management of aneurysmal subarachnoid haemorrhage based on computed tomography angiography.
- Maldaner N Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland. nicolai.maldaner@usz.ch.
- Burkhardt JK Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Stienen MN Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Goldberg J Department of Neurosurgery, University Hospital Bern, Bern, Switzerland.
- Bervini D Department of Neurosurgery, University Hospital Bern, Bern, Switzerland.
- Bijlenga P Department of Neurosurgery, University Clinic Geneva, Geneva, Switzerland.
- Croci D Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
- Zumofen D Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
- D'Alonzo D Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
- Marbacher S Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
- Maduri R Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
- Daniel RT Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
- Serra C Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Esposito G Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Neidert MC Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Bozinov O Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Regli L Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- 2017-12-08
Published in:
- Acta neurochirurgica. - 2018
Aneurysm morphology
CT angiography
Inter-rater agreement
Inter-rater reliability
Neurovascular imaging
Subarachnoid haemorrhage
Aged
Aneurysm, Ruptured
Cerebral Hemorrhage
Clinical Decision-Making
Computed Tomography Angiography
Endovascular Procedures
Female
Humans
Intracranial Aneurysm
Male
Middle Aged
Neurosurgeons
Neurosurgical Procedures
Rupture, Spontaneous
Stents
Subarachnoid Hemorrhage
Vascular Surgical Procedures
English
BACKGROUND
To determine the neurosurgeon's agreement in aneurysmal subarachnoid haemorrhage (aSAH) management with special emphasis on the rater's level of experience. A secondary aim was to analyse potential aneurysm variables associated with the therapeutic recommendation.
METHOD
Basic clinical information and admission computed tomography angiography (CTA) images of 30 consecutive aSAH patients were provided. Twelve neurosurgeons independently evaluated aneurysm characteristics and gave recommendations regarding the emergency management and aneurysm occlusion therapy. Inter-rater variability and predictors of treatment recommendation were evaluated.
RESULTS
There was an overall moderate agreement in treatment decision [κ = 0.43; 95% confidence interval ((CI), 0.387-0.474] with moderate agreement for surgical (κ = 0.43; 95% CI, 0.386-0.479) and endovascular treatment recommendation (κ = 0.45; 95% CI, 0.398-0.49). Agreement on detailed treatment recommendations including clip, coil, bypass, stent, flow diverter and ventriculostomy was low to moderate. Inter-rater agreement did not significantly differ between residents and consultants. Middle cerebral artery (MCA) aneurysm location was a positive predictor of surgical treatment [odds ratio (OR), 49.57; 95% CI, 10.416-235.865; p < 0.001], while patients aged >65 years (OR, 0.12; 95% CI, 0.03-0.0434; p = 0.001), fusiform aneurysm type (OR, 0.18; 95% CI, 0.044-0.747; p = 0.018) and intracerebral haematoma (ICA) aneurysm location (OR, 0.24; 95% CI, 0.088-0.643; p = 0.005) were associated with a recommendation for endovascular treatment.
CONCLUSIONS
Agreement on aSAH management varies considerably across neurosurgeons, while therapeutic decision-making is challenging on an individual patient level. However, patients aged >65 years, fusiform aneurysm shape and ICA location were associated with endovascular treatment recommendation, while MCA aneurysm location remains a surgical domain in the opinion of neurosurgeons without formal endovascular training.
To determine the neurosurgeon's agreement in aneurysmal subarachnoid haemorrhage (aSAH) management with special emphasis on the rater's level of experience. A secondary aim was to analyse potential aneurysm variables associated with the therapeutic recommendation.
METHOD
Basic clinical information and admission computed tomography angiography (CTA) images of 30 consecutive aSAH patients were provided. Twelve neurosurgeons independently evaluated aneurysm characteristics and gave recommendations regarding the emergency management and aneurysm occlusion therapy. Inter-rater variability and predictors of treatment recommendation were evaluated.
RESULTS
There was an overall moderate agreement in treatment decision [κ = 0.43; 95% confidence interval ((CI), 0.387-0.474] with moderate agreement for surgical (κ = 0.43; 95% CI, 0.386-0.479) and endovascular treatment recommendation (κ = 0.45; 95% CI, 0.398-0.49). Agreement on detailed treatment recommendations including clip, coil, bypass, stent, flow diverter and ventriculostomy was low to moderate. Inter-rater agreement did not significantly differ between residents and consultants. Middle cerebral artery (MCA) aneurysm location was a positive predictor of surgical treatment [odds ratio (OR), 49.57; 95% CI, 10.416-235.865; p < 0.001], while patients aged >65 years (OR, 0.12; 95% CI, 0.03-0.0434; p = 0.001), fusiform aneurysm type (OR, 0.18; 95% CI, 0.044-0.747; p = 0.018) and intracerebral haematoma (ICA) aneurysm location (OR, 0.24; 95% CI, 0.088-0.643; p = 0.005) were associated with a recommendation for endovascular treatment.
CONCLUSIONS
Agreement on aSAH management varies considerably across neurosurgeons, while therapeutic decision-making is challenging on an individual patient level. However, patients aged >65 years, fusiform aneurysm shape and ICA location were associated with endovascular treatment recommendation, while MCA aneurysm location remains a surgical domain in the opinion of neurosurgeons without formal endovascular training.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1007/s00701-017-3415-6
- PMID 29214402
- Persistent URL
- https://sonar.ch/global/documents/185059
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