Department of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower 6115C, Baltimore, MD, 21287, USA.
Neurosurg Rev. 2021 Dec;44(6):3487-3498. doi: 10.1007/s10143-021-01523-3. Epub 2021 Apr 2.
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.
当前的风险分层量表，如未破裂颅内动脉瘤治疗评分（UIATS）和 PHASES 评分的预测价值存在争议。我们使用破裂颅内动脉瘤队列评估了这些评分，如果相同的患者在破裂前出现，模拟了它们的管理建议。使用我们机构前瞻性维护的破裂囊状动脉瘤患者数据库。对 992 例连续就诊于我院的患者计算了 PHASES 评分，对 266 例连续就诊于我院的患者计算了 UIATS 评分。由于计算所需的变量较多，因此为 UIATS 队列选择了较短的时间段。比较了 UIATS 推荐的“观察”动脉瘤和所有其他动脉瘤之间的临床结果。在 992 例破裂动脉瘤中，54%的 PHASES 评分较低（≤5）。在 266 例破裂动脉瘤中，UIATS 的推荐意见如下：68（26%）“观察”，97（36%）“治疗”，101（38%）“非确定性”。UIATS 保守治疗组患者发生更多与蛛网膜下腔出血相关的并发症（78%比 65%，p=0.043），非家庭出院率更高（74%比 46%，p<0.001），且 12-18 个月后功能状态较差（改良 Rankin 量表>2）的发生率更高（68%比 51%，p=0.014）。目前用于未破裂动脉瘤的预测评分系统可能低估了未来的破裂风险，并导致一些患者采取更保守的治疗策略。推荐保守治疗的患者在破裂后更有可能出现不良结局。
