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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleNeurointervention

Factors Influencing Confidence in Diagnostic Ratings and Retreatment Recommendations in Coiled Aneurysms

M. Ernst, L. Kriston, M. Groth, A.M. Frölich, J. Fiehler and J.-H. Buhk
American Journal of Neuroradiology March 2018, DOI: https://doi.org/10.3174/ajnr.A5581
M. Ernst
aFrom the Department of Diagnostic and Interventional Neuroradiology (M.E., M.G., A.M.F., J.F., J.-H.B.), Center for Radiology and Endoscopy
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  • ORCID record for M. Ernst
L. Kriston
bDepartment of Medical Psychology (L.K.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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  • ORCID record for L. Kriston
M. Groth
aFrom the Department of Diagnostic and Interventional Neuroradiology (M.E., M.G., A.M.F., J.F., J.-H.B.), Center for Radiology and Endoscopy
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A.M. Frölich
aFrom the Department of Diagnostic and Interventional Neuroradiology (M.E., M.G., A.M.F., J.F., J.-H.B.), Center for Radiology and Endoscopy
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J. Fiehler
aFrom the Department of Diagnostic and Interventional Neuroradiology (M.E., M.G., A.M.F., J.F., J.-H.B.), Center for Radiology and Endoscopy
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J.-H. Buhk
aFrom the Department of Diagnostic and Interventional Neuroradiology (M.E., M.G., A.M.F., J.F., J.-H.B.), Center for Radiology and Endoscopy
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Article Figures & Data

Tables

  • Table1

    Figure: Case characteristics and retreatment recommendations

    • Note:—Acom indicates anterior communicating artery; Pcom, posterior communicating artery; A., arteria.

    • a Rated from complete occlusion, neck remnant, to residual aneurysm.

    • b Rated from better, same, to worse.

    • c Rated from completely uncertain (1) to completely certain (6).

    • d Rated from standard, difficult, to unbearable risk.

    • e Rated from coiling only, stent-assisted coiling, clipping, other, or no retreatment.

    • View popup
    Table 1:

    Results from linear (generalized) mixed modelling investigating the association between case characteristics with confidence in assessment, general retreatment recommendation (any retreatment), and specific retreatment recommendations (coiling, stent and coiling, clipping, other endovascular treatment)

    Confidencea βAny Retreatmentb Odds RatioCoiling Onlyb Odds RatioStent and Coilingb Odds RatioClippingb Odds RatioOther Endovascular Treatmentb Odds Ratio
    Case characteristics
        Locationc0.13000.62580.98871.42880.02410.1635i
        Bleedingd0.04320.76380.70220.92311.75820.7084
        Aneurysm size (mm)0.00040.99591.00060.9873i1.01981.0072
        Aneurysm neck width (mm)−0.04470.90880.7354i1.3879i0.4234i0.8492
        Patient ageeNA0.2522j0.3529j0.2171j0.1879j0.2796j
    Casewise averaged ratings across raters
        Proportion rating residual gradef0.468386.2958j79.9203j141.9125j118.82537.3950
        Proportion rating worseningg1.1790j2.27091.27542.75370.20788.3006
        Proportion rating difficult retreatmenth−0.23870.42000.0282i0.390999.97331.6362
        Mean confidenceNA2.7197j2.46972.23265.13440.9219
    • Note:—NA indicates not analyzed.

    • ↵a Rated from completely uncertain (1) to completely certain (6).

    • ↵b Binary compared with no treatment; odds ratios of >1 indicate a higher probability of treatment, and odds ratios of <1 indicate a lower probability of treatment with an increase in the predictors.

    • ↵c Posterior (1) versus anterior (0).

    • ↵d Ruptured (1) versus asymptomatic (0).

    • ↵e Elderly, older than 50 years, (1) versus younger, 50 years or younger (0).

    • ↵f Proportion of ratings of residual versus complete/neck remnant aneurysm from 0 to 1.

    • ↵g Proportion of ratings of worse-versus-the same/better condition from 0 to 1.

    • ↵h Proportion of ratings of difficult/unbearably risky versus standard retreatment from 0 to 1.

    • ↵i P < .050.

    • ↵j P < .00.

    • View popup
    Table 2:

    Results from linear (generalized) mixed modelling investigating the association between rater and case characteristics with confidence in assessment, general retreatment recommendation (any retreatment), and specific retreatment recommendations (coiling, stent and coiling, clipping, other endovascular treatment)

    Confidencea βAny Retreatmentb Odds RatioCoiling Onlyb Odds RatioStent and Coilingb Odds RatioClippingb Odds RatioOther Endovascular Treatmentb Odds Ratio
    Rater characteristics
        Work experiencec0.04660.72800.98970.85690.3882d0.7475
        Aneurysm treatment experiencec0.01081.09291.11900.85711.22921.1915
        Knowledgec0.04111.47611.8102d1.11981.53971.3269
        Skillsc0.05740.79450.76051.09040.66670.7735
    • ↵a Rated from completely uncertain (1) to completely certain (6).

    • ↵b Binary compared with no treatment; odds ratios of >1 indicate a higher probability of treatment, and odds ratios of <1 indicate a lower probability of treatment with an increase in the predictors.

    • ↵c In SD units.

    • ↵d P < .050.

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M. Ernst, L. Kriston, M. Groth, A.M. Frölich, J. Fiehler, J.-H. Buhk
Factors Influencing Confidence in Diagnostic Ratings and Retreatment Recommendations in Coiled Aneurysms
American Journal of Neuroradiology Mar 2018, DOI: 10.3174/ajnr.A5581

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Factors Influencing Confidence in Diagnostic Ratings and Retreatment Recommendations in Coiled Aneurysms
M. Ernst, L. Kriston, M. Groth, A.M. Frölich, J. Fiehler, J.-H. Buhk
American Journal of Neuroradiology Mar 2018, DOI: 10.3174/ajnr.A5581
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