J Stroke.
2019 Sep;21(3):340-346. 10.5853/jos.2019.01277.
External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk
- Affiliations
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- 1Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands. m.d.i.vergouwen@umcutrecht.nl
- 2Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands.
- 3Department of Neurosurgery, University of Toyama, Toyama, Japan.
- 4Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
- 5Department of Neurosurgery, Kyorin University, Tokyo, Japan.
- 6Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan.
- 7Department of Neuroradiology, Toulouse University Hospital, Toulouse, France.
- 8Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland.
- 9Institute of Clinical Medicine-Neurosurgery, University of Eastern Finland, Kuopio, Finland.
- 10Department of Neurosurgery, University of Tampere, Tampere, Finland.
- 11Department of Neurosurgery, University of Turku, Turku, Finland.
- 12Department of Neuroradiology, Academic Medical Center, Amsterdam, the Netherlands.
- 13Department of Biomedical Engineering and Physics,Academic Medical Center, Amsterdam, the Netherlands.
- 14Department of Neurosurgery, Academic Medical Center, Amsterdam, the Netherlands.
- 15Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands.
- 16Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands.
- 17Department of Neurology, Haaglanden Medical Center, Den Haag, the Netherlands.
- 18Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
- 19Department of Radiology, Haaglanden Medical Center, Den Haag, the Netherlands.
- 20Department of Neurosurgery, Institute of Neurological Science, Glasgow, UK.
- 21Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- KMID: 2464651
- DOI: http://doi.org/10.5853/jos.2019.01277
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.
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