Evidence map›Paper›PMID 33797630›Full record

ArticleNeurosurgical review2021

Application of unruptured aneurysm scoring systems to a cohort of ruptured aneurysms: are we underestimating rupture risk?

James Feghali, Abhishek Gami, Risheng Xu, Christopher M Jackson, Rafael J Tamargo, Cameron G McDougall, Judy Huang, Justin M Caplan

Abstract read
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In one paragraph

Article in Neurosurgical review, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

James Feghali *Department of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower 6115C, Baltimore, MD, 21287, USA.
Abhishek Gami *Department of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower 6115C, Baltimore, MD, 21287, USA.
Risheng XuDepartment of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower 6115C, Baltimore, MD, 21287, USA.
Christopher M JacksonDepartment of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower 6115C, Baltimore, MD, 21287, USA.
Rafael J TamargoDepartment of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower 6115C, Baltimore, MD, 21287, USA.
Cameron G McDougallDepartment of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower 6115C, Baltimore, MD, 21287, USA.
Judy HuangDepartment of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower 6115C, Baltimore, MD, 21287, USA.
Justin M CaplanDepartment of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower 6115C, Baltimore, MD, 21287, USA. JustinCaplan@jhmi.edu.ORCID http://orcid.org/0000-0002-0289-3661

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The predictive values of current risk stratification scales such as the Unruptured Intracranial Aneurysm Treatment Score (UIATS) and the PHASES score are debatable. We evaluated these scores using a cohort of ruptured intracranial aneurysms to simulate their management recommendations had the exact same patients presented prior to rupture. A prospectively maintained database of ruptured saccular aneurysm patients presenting to our institution was used. The PHASES score was calculated for 992 consecutive patients presenting between January 2002 and December 2018, and the UIATS was calculated for 266 consecutive patients presenting between January 2013 and December 2018. A shorter period was selected for the UIATS cohort given the larger number of variables required for calculation. Clinical outcomes were compared between UIATS-recommended "observation" aneurysms and all other aneurysms. Out of 992 ruptured aneurysms, 54% had a low PHASES score (≤5). Out of the 266 ruptured aneurysms, UIATS recommendations were as follows: 68 (26%) "observation," 97 (36%) "treatment," and 101 (38%) "non-definitive." The UIATS conservative group of patients developed more SAH-related complications (78% vs. 65%, p=0.043), had a higher rate of non-home discharge (74% vs. 46%, p<0.001), and had a greater incidence of poor functional status (modified Rankin scale >2) after 12-18 months (68% vs. 51%, p=0.014). Current predictive scoring systems for unruptured aneurysms may underestimate future rupture risk and lead to more conservative management strategies in some patients. Patients that would have been recommended for conservative therapy were more likely to have a worse outcome after rupture.

Indexed as

Aneurysm, RupturedIntracranial AneurysmSubarachnoid HemorrhageCohort StudiesConservative TreatmentHumansRetrospective StudiesRisk FactorsAneurysmClinical decision-makingRupturedSubarachnoid hemorrhage

Identifiers

PMID33797630

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.