Dippel D W, ter Berg J W, Habbema J D
Center for Clinical Decision Sciences, Medical Faculty Erasmus University, Rotterdam, The Netherlands.
Acta Neurol Scand. 1992 Oct;86(4):381-9. doi: 10.1111/j.1600-0404.1992.tb05105.x.
Decision analysis is used to assess the decision to screen for unruptured intracranial aneurysms (IAs) in two affected families, and to formulate guide-lines for similar decisions. Four strategies are compared: "no screening", "screening directly", "screening twice", and "screening later". Intravenous and intra-arterial digital subtraction angiography techniques (iv-DSA, ia-DSA) are considered. Life years lived with and without disability are computed for each strategy. Loss of life expectancy with and without discounting and quality correction is used as an outcome measure. "No screening" is the preferred strategy when population based estimates of the prevalence of IAs are used. Thus, the results of this analysis provide no justification for screening patients without a familial history. But a physician who thinks that the risk of an IA is increased may rightly decide for screening, especially when the patient is aged 40 to 60. Ia-DSA is preferable over iv-DSA. A scenario analysis suggests that screening with magnetic resonance angiography is only slightly better than with ia-DSA, because the complication rate of screening plays a minor role in the analysis.
决策分析用于评估在两个患病家族中筛查未破裂颅内动脉瘤（IA）的决策，并为类似决策制定指导方针。比较了四种策略：“不筛查”、“直接筛查”、“筛查两次”和“稍后筛查”。考虑了静脉和动脉数字减影血管造影技术（静脉DSA、动脉DSA）。计算每种策略下有残疾和无残疾的生存年数。将有无贴现和质量校正的预期寿命损失用作结果指标。当使用基于人群的IA患病率估计值时，“不筛查”是首选策略。因此，该分析结果无法为无家族史患者的筛查提供依据。但认为IA风险增加的医生可能正确地决定进行筛查，尤其是当患者年龄在40至60岁时。动脉DSA优于静脉DSA。情景分析表明，磁共振血管造影筛查仅比动脉DSA略好，因为筛查的并发症发生率在分析中起的作用较小。
