Introduction Patients who have unruptured intracranial aneurysms (UIAs) might receive different clinical advice from different clinicians. This can be bewildering and distressing for them, as their condition could be fatal.
Aim of Study To analyse the levels of interobserver agreement in clinical decisions among three endovascular neurosurgeons at the same hospital using a newly developed grade of recommendation (GOR) system.
Methods We selected 161 consecutive patients with 202 UIAs for this study. The GOR system consists of six grades, which indicate various clinicians’ recommendations, including treatment or no-treatment. The three observers reviewed medical records and digital subtraction angiography, then marked corresponding GORs for the case aneurysms. Interobserver agreement was analysed with Fleiss’ kappa values.
Results The overall Fleiss’ kappa was 0.52 among the three observers, indicating a moderate level of interobserver agreement. It was relatively high in grade 1 and grade 5. It was the lowest in grade 3. When GORs were classified as treatment, middle and no-treatment groups, the overall kappa value was 0.84, indicating almost perfect.
Conclusion The level of interobserver agreement was very high in terms of treatment versus no-treatment, but moderate regarding the strength of the recommendation. Further studies are needed to clarify the detailed reasons for the similarities and differences of the clinicians’ recommendations.
Disclosure of Interest Nothing to disclose
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