Decision-making and neurosurgeons' agreement in the management of aneurysmal subarachnoid haemorrhage based on computed tomography angiography.

Details

Serval ID
serval:BIB_7112A0F55FA1
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Decision-making and neurosurgeons' agreement in the management of aneurysmal subarachnoid haemorrhage based on computed tomography angiography.
Journal
Acta neurochirurgica
Author(s)
Maldaner N., Burkhardt J.K., Stienen M.N., Goldberg J., Bervini D., Bijlenga P., Croci D., Zumofen D., D'Alonzo D., Marbacher S., Maduri R., Daniel R.T., Serra C., Esposito G., Neidert M.C., Bozinov O., Regli L.
ISSN
0942-0940 (Electronic)
ISSN-L
0001-6268
Publication state
Published
Issued date
02/2018
Peer-reviewed
Oui
Volume
160
Number
2
Pages
253-260
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
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.
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.
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.
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.
Keywords
Aged, Aneurysm, Ruptured/diagnostic imaging, Aneurysm, Ruptured/surgery, Cerebral Hemorrhage/diagnostic imaging, Clinical Decision-Making, Computed Tomography Angiography, Endovascular Procedures, Female, Humans, Intracranial Aneurysm/diagnosis, Intracranial Aneurysm/surgery, Male, Middle Aged, Neurosurgeons, Neurosurgical Procedures, Rupture, Spontaneous, Stents, Subarachnoid Hemorrhage/diagnostic imaging, Subarachnoid Hemorrhage/surgery, Vascular Surgical Procedures, Aneurysm morphology, CT angiography, Inter-rater agreement, Inter-rater reliability, Neurovascular imaging, Subarachnoid haemorrhage
Pubmed
Web of science
Create date
14/12/2017 18:11
Last modification date
20/08/2019 14:29
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