Concordance between the Unruptured Intracranial Aneurysm Treatment Score (UIATS), Earlier Subarachnoid Hemorrhage, Location, Age, Population, Size, Shape (ELAPSS) score, and Population, Hypertension, Age, Size, Earlier Subarachnoid Hemorrhage, Site (PHASES) score with real-world management decisions in unruptured intracranial aneurysms (UIAs) remains unclear, especially in current practice. This study aimed to investigate this concordance, while developing an optimal model predictive of recent decision practices at a quaternary referral center. A prospective database of patients presenting with UIAs to our institution from January 1 to December 31, 2018, was used. Concordance between the scores and real-world management decisions on every UIA was assessed. Complications and length of stay (LOS) were compared between aneurysms in the UIATS-recommended treatment and observation groups. A subgroup analysis of concordance was also conducted among junior and senior surgeons. An optimal logistic regression model predictive of real-world decisions was also derived. The cohort consisted of 198 patients with 271 UIAs, of which 42% were treated. The UIATS demonstrated good concordance with an AUC of 0.765. Of the aneurysms in the UIATS-recommended "observation" group, 22% were discordantly treated. The ELAPSS score demonstrated good discrimination (AUC = 0.793), unlike the PHASES score (AUC = 0.579). Endovascular treatment rates, complications, and LOS were similar between aneurysms in the UIATS-recommended treatment and observation groups. Similar concordance was obtained among junior and senior surgeons. The optimal predictive model consisted of several significantly associated variables and had an AUC of 0.942. Cerebrovascular specialists may be treating aneurysms slightly more than these scores would recommend, independently of years in practice. Wide variation still exists in management practices of UIAs.

中文翻译：

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未破裂颅内动脉瘤的管理：UIATS、ELAPSS 和 PHASES 与转诊中心实践的相关性。

未破裂颅内动脉瘤治疗评分 (UIATS)、早期蛛网膜下腔出血、位置、年龄、人群、大小、形状 (ELAPSS) 评分和人群、高血压、年龄、大小、早期蛛网膜下腔出血、部位 (PHASES) 评分与真实的一致性- 未破裂颅内动脉瘤 (UIA) 的世界管理决策仍不清楚，尤其是在目前的实践中。本研究旨在调查这种一致性，同时开发一个最佳模型来预测四级转诊中心最近的决策实践。使用了 2018 年 1 月 1 日至 12 月 31 日在我们机构就诊的 UIA 患者的前瞻性数据库。评估了每个 UIA 的分数与实际管理决策之间的一致性。比较了 UIATS 推荐治疗组和观察组中动脉瘤的并发症和住院时间 (LOS)。还对初级和高级外科医生进行了亚组一致性分析。还推导出了预测现实世界决策的最佳逻辑回归模型。该队列包括 198 名患者和 271 名 UIA，其中 42% 接受了治疗。UIATS 表现出良好的一致性，AUC 为 0.765。在 UIATS 推荐的“观察”组中，22% 的动脉瘤得到了不一致的治疗。ELAPSS 分数表现出良好的辨别力 (AUC = 0.793)，与 PHASES 分数 (AUC = 0.579) 不同。UIATS 推荐治疗组和观察组的动脉瘤血管内治疗率、并发症和 LOS 相似。在初级和高级外科医生中获得了类似的一致性。最佳预测模型由几个显着相关的变量组成，AUC 为 0.942。脑血管专家治疗动脉瘤的程度可能略高于这些分数所推荐的，与实践多年无关。UIA 的管理实践仍然存在很大差异。