ArticleJournal of cerebrovascular and endovascular neurosurgery2026
Interobserver agreement among clinicians in the treatment recommendations for patients with unruptured intracranial aneurysms.
Article in Journal of cerebrovascular and endovascular neurosurgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
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5 authors.
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Abstract
objectiveIn practice, variability in clinical decisions among clinicians can exist and may be acceptable. However, from the patient's standpoint, particularly for those with potentially life-threatening conditions such as unruptured intracranial aneurysms (UIAs), this variability can be confusing and concerning. In this study, the levels of interobserver agreement in clinical decisions among three endovascular neurosurgeons working at the same hospital were analyzed using a newly developed grade of recommendation (GOR) system.
methodsA total of 161 consecutive patients with 202 UIAs were included in this study. The GOR system consists of six grades, representing various clinicians' recommendations, including treatment or no-treatment. The three observers reviewed the medical records and digital subtraction angiography images, and then assigned the corresponding GORs for each aneurysm. Interobserver agreement was analyzed using Fleiss' kappa values.
resultsThe overall Fleiss' kappa among three observers was 0.52, indicating a moderate level of interobserver agreement. The agreement was relatively high for grades 1 and 5. It was the lowest for grade 3. When GORs were classified as treatment, middle and no-treatment groups, the overall kappa value was 0.84, indicating almost perfect.
conclusionsThis study shows that the level of interobserver agreement was very high for treatment versus no-treatment decisions, but moderate regarding the strength of the recommendations. Further studies are needed to clarify the detailed reasons for the similarities and differences in clinicians' recommendations.
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