Journal of Stroke (Sep 2019)
External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk
- Mayte Sánchez van Kammen,
- Jacoba P. Greving,
- Satoshi Kuroda,
- Daina Kashiwazaki,
- Akio Morita,
- Yoshiaki Shiokawa,
- Toshikazu Kimura,
- Christophe Cognard,
- Anne C. Januel,
- Antti Lindgren,
- Timo Koivisto,
- Juha E. Jääskeläinen,
- Antti Ronkainen,
- Liisa Pyysalo,
- Juha Öhman,
- Melissa Rahi,
- Johanna Kuhmonen,
- Jaakko Rinne,
- Eva L. Leemans,
- Charles B. Majoie,
- W. Peter Vandertop,
- Dagmar Verbaan,
- Yvo B.W.E.M. Roos,
- René van den Berg,
- Hieronymus D. Boogaarts,
- Walid Moudrous,
- Ido R. van den Wijngaard,
- Laura ten Hove,
- Mario Teo,
- Edward J. St George,
- Katharina A.M. Hackenberg,
- Amr Abdulazim,
- Nima Etminan,
- Gabriël J.E. Rinkel,
- Mervyn D.I. Vergouwen
Affiliations
- Mayte Sánchez van Kammen
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
- Jacoba P. Greving
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
- Satoshi Kuroda
- Department of Neurosurgery, University of Toyama, Toyama, Japan
- Daina Kashiwazaki
- Department of Neurosurgery, University of Toyama, Toyama, Japan
- Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
- Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University, Tokyo, Japan
- Toshikazu Kimura
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
- Christophe Cognard
- Department of Neuroradiology, Toulouse University Hospital, Toulouse, France
- Anne C. Januel
- Department of Neuroradiology, Toulouse University Hospital, Toulouse, France
- Antti Lindgren
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
- Timo Koivisto
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
- Juha E. Jääskeläinen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
- Antti Ronkainen
- Department of Neurosurgery, University of Tampere, Tampere, Finland
- Liisa Pyysalo
- Department of Neurosurgery, University of Tampere, Tampere, Finland
- Juha Öhman
- Department of Neurosurgery, University of Tampere, Tampere, Finland
- Melissa Rahi
- Department of Neurosurgery, University of Turku, Turku, Finland
- Johanna Kuhmonen
- Department of Neurosurgery, University of Turku, Turku, Finland
- Jaakko Rinne
- Department of Neurosurgery, University of Turku, Turku, Finland
- Eva L. Leemans
- Department of Neuroradiology, Academic Medical Center, Amsterdam, the Netherlands
- Charles B. Majoie
- Department of Neuroradiology, Academic Medical Center, Amsterdam, the Netherlands
- W. Peter Vandertop
- Department of Neurosurgery, Academic Medical Center, Amsterdam, the Netherlands
- Dagmar Verbaan
- Department of Neurosurgery, Academic Medical Center, Amsterdam, the Netherlands
- Yvo B.W.E.M. Roos
- Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
- René van den Berg
- Department of Neuroradiology, Academic Medical Center, Amsterdam, the Netherlands
- Hieronymus D. Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
- Walid Moudrous
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
- Ido R. van den Wijngaard
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Laura ten Hove
- Department of Radiology, Haaglanden Medical Center, Den Haag, the Netherlands
- Mario Teo
- Department of Neurosurgery, Institute of Neurological Science, Glasgow, UK
- Edward J. St George
- Department of Neurosurgery, Institute of Neurological Science, Glasgow, UK
- Katharina A.M. Hackenberg
- Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Amr Abdulazim
- Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Nima Etminan
- Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Gabriël J.E. Rinkel
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
- Mervyn D.I. Vergouwen
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
- DOI
- https://doi.org/10.5853/jos.2019.01277
- Journal volume & issue
-
Vol. 21,
no. 3
pp. 340 – 346
Abstract
Background and Purpose Prediction of intracranial aneurysm growth risk can assist physicians in planning of follow-up imaging of conservatively managed unruptured intracranial aneurysms. We therefore aimed to externally validate the ELAPSS (Earlier subarachnoid hemorrhage, aneurysm Location, Age, Population, aneurysm Size and Shape) score for prediction of the risk of unruptured intracranial aneurysm growth. Methods From 11 international cohorts of patients ≥18 years with ≥1 unruptured intracranial aneurysm and ≥6 months of radiological follow-up, we collected data on the predictors of the ELAPSS score, and calculated 3- and 5-year absolute growth risks according to the score. Model performance was assessed in terms of calibration (predicted versus observed risk) and discrimination (c-statistic). Results We included 1,072 patients with a total of 1,452 aneurysms. During 4,268 aneurysm-years of follow-up, 199 (14%) aneurysms enlarged. Calibration was comparable to that of the development cohort with the overall observed risks within the range of the expected risks. The c-statistic was 0.69 (95% confidence interval [CI], 0.64 to 0.73) at 3 years, compared to 0.72 (95% CI, 0.68 to 0.76) in the development cohort. At 5 years, the c-statistic was 0.68 (95% CI, 0.64 to 0.72), compared to 0.72 (95% CI, 0.68 to 0.75) in the development cohort. Conclusions The ELAPSS score showed accurate calibration for 3- and 5-year risks of aneurysm growth and modest discrimination in our external validation cohort. This indicates that the score is externally valid and could assist patients and physicians in predicting growth of unruptured intracranial aneurysms and plan follow-up imaging accordingly.
Keywords
- unruptured intracranial aneurysm
- risk factors
- aneurysm growth
- model validation
- subarachnoid hemorrhage
- prevention
