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The Delphi Oracle and the management of aneurysms
  1. Robert Fahed1,
  2. Tim E Darsaut2
  1. 1Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada
  2. 2Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
  1. Correspondence to Dr Tim E Darsaut, Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, 8440-112th Street, WMC 2C3.83, Edmonton, Alberta, Canada T6G 2B7; tdarsaut{at}ualberta.ca

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The history of human opinion is scarcely anything more than the history of human error. Voltaire1

The knowledge vacuum surrounding the management of unruptured intracranial aneurysms (UIAs) persists. It is acknowledged that good quality (randomized) data on which to base clinical decisions do not exist. However, this has not stopped the manufacture of non-evidence-based devices used to justify approaches where clinical decisions are made. The most recently published offering is the ‘Unruptured Intracranial Aneurysm Treatment Score (UIATS)’, generated via consensus sessions with world-renowned leaders.2 Notably, this iterative process is termed a ‘Delphi’ consensus, which should readily differentiate it from conventional scientific endeavors.

The UIATS is a complex score that combines patient-related, aneurysm-related, and treatment-related factors, and attributes 0–5 points per item, resulting in two columns of numerical values—one favoring aneurysm repair and the other favoring conservative management. A divergence in score of ≥3 between the columns yields a ‘definitive’ management recommendation.2

With this system, several inconsistencies are concealed …

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