在未破裂的内动脉瘤患者的微手术管理中,现实世界和基于分数的决策之间的差异
Sandro Hügli1,2, Victor E Staartjes1,2, Martina Sebök1,2
1Department of Neurosurgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
Journal of neurosurgical sciences
|June 12, 2023
概括
对于未破裂的内动脉瘤 (UIAs) 的临床决定往往与预测得分有所不同. 血管解剖学和患者因素驱动治疗,突出需要改进UIA预测模型.
科学领域:
- 神经外科 神经外科
- 医疗决策的制定 医疗决策的制定
- 生物统计学 生物统计学
背景情况:
- 未破裂的内动脉瘤 (UIA) 的管理需要平衡破裂和治疗风险.
- 预测分数旨在帮助临床医生在UIA管理决策中.
- 本研究分析了微手术治疗UIA的预测得分和跨学科董事会决定之间的差异.
研究的目的:
- 将UIA预测得分 (UIATS,PHASES,ELAPSS) 的建议与大脑血管委员会实际做出的临床决定进行比较.
- 确定影响治疗决策的因素,当它们偏离评分建议时.
主要方法:
- 对221名患有276例微手术治疗的UIA患者的回顾性分析 (2013年1月 - 2020年6月).
- 计算每个动脉瘤的UIATS,PHASES和ELAPSS得分.
- 收集和分析跨学科大脑血管委员会决策因素.
主要成果:
- 预测得分建议在动脉瘤的29.3%至39.9%情况下进行保守的管理.
- 驱动治疗的因素尽管保守的得分建议包括高预期寿命 (50.0%),血管解剖因素 (25.0%),动脉瘤多重 (16.7%).
- 血管解剖学因素 (UIATS),临床风险因素 (PHASES,ELAPSS) 和患者的愿望显著影响了治疗决策.
结论:
- 对于UIAs,现实世界的临床决策经常与预测得分建议有所不同.
- 现有的分数 (UIATS,PHASES,ELAPSS) 在评估血管解剖学,临床风险因素和患者特征方面存在局限性.
- 优化UIA预测模型是必要的,以更好地反映复杂的临床决策.
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