ArticleBrain & spine2026
Treatment variation in acute management of patients with aneurysmal subarachnoid hemorrhage: a multicenter case vignette study.
Article in Brain & spine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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13 authors.
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Abstract
Background: Although a landmark randomized controlled trial (RCT) compared clipping with coiling in aneurysmal subarachnoid hemorrhage (aSAH), real-world practice remains heterogeneous. Advances in endovascular and microsurgical techniques, complex or borderline cases not well represented in trials, and differences in institutional expertise likely contribute to between-center variation. Understanding these treatment preferences is critical for identifying potential unwarranted variation and designing comparative effectiveness research that reflects decision-making. Methods: A multicenter case-vignette study was conducted across five Dutch tertiary referral centers for aSAH (n = 16 specialists) between May and October 2025. Fifteen real-world aSAH vignettes, representing diverse clinical and radiological profiles, were systematically presented during live meetings of the local neurovascular multidisciplinary teams (MDT), including neurologists, neurosurgeons, and interventional-radiologists. For each case, MDTs proposed an aneurysm treatment strategy. Between-center variation was quantified using Fleiss' κ with 95% confidence intervals (CI). Results: Of 15 case vignettes, agreement on aneurysm treatment strategy among at least four of five centers was reached in 12 cases (80%). Regarding treatment modality, at least four of five centers opted for a similar modality in 10 of 11 cases (91%). The proportion of clipping versus any endovascular treatment option ranged between centers from 2/12 aneurysm treatments proposals (17%) to 8/13 proposals (62%), resulting in moderate agreement (κ = 0.49, 95% CI 0.31-0.68) for between-center variation. Conclusion: There is between-center variation in treatment strategies for ruptured intracranial aneurysms across Dutch tertiary referral centers for aSAH in identical case vignettes. These case-mix independent, center-level preferences may be leveraged for comparative effectiveness research.
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