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

doi:10.5853/jos.2019.01277

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 MajoieW 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

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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.

CONCLUSION: s 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.

Original language	English
Pages (from-to)	340-346
Number of pages	7
Journal	Stroke
Volume	21
Issue number	3
DOIs	https://doi.org/10.5853/jos.2019.01277
Publication status	Published - Sept 2019

Keywords

Aneurysm growth
Model validation
Prevention
Risk factors
Subarachnoid hemorrhage
Unruptured intracranial aneurysm

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Kammen, M. S. V., Greving, J. P., Kuroda, S., Kashiwazaki, D., Morita, A., Shiokawa, Y., Kimura, T., Cognard, C., Januel, A. C., Lindgren, A., Koivisto, T., Jääskeläinen, J. E., Ronkainen, A., Pyysalo, L., Öhman, J., Rahi, M., Kuhmonen, J., Rinne, J., Leemans, E. L., ... Vergouwen, M. D. I. (2019). External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk. Stroke, 21(3), 340-346. https://doi.org/10.5853/jos.2019.01277

@article{684c563f64bb4599b7abe072d3c5aef2,

title = "External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk",

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.CONCLUSION: s 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 = "Aneurysm growth, Model validation, Prevention, Risk factors, Subarachnoid hemorrhage, Unruptured intracranial aneurysm",

author = "Kammen, {Mayte S{\'a}nchez van} and Greving, {Jacoba P} and Satoshi Kuroda and Daina Kashiwazaki and Akio Morita and Yoshiaki Shiokawa and Toshikazu Kimura and Christophe Cognard and Januel, {Anne C} and Antti Lindgren and Timo Koivisto and J{\"a}{\"a}skel{\"a}inen, {Juha E} and Antti Ronkainen and Liisa Pyysalo and Juha {\"O}hman and Melissa Rahi and Johanna Kuhmonen and Jaakko Rinne and Leemans, {Eva L} and Majoie, {Charles B} and Vandertop, {W Peter} and Dagmar Verbaan and Roos, {Yvo B W E M} and Berg, {Ren{\'e} van den} and Boogaarts, {Hieronymus D} and Walid Moudrous and Wijngaard, {Ido R van den} and Hove, {Laura Ten} and Mario Teo and George, {Edward J St} and Hackenberg, {Katharina A M} and Amr Abdulazim and Nima Etminan and Rinkel, {Gabri{\"e}l J E} and Vergouwen, {Mervyn D I}",

note = "Publisher Copyright: {\textcopyright} 2019 Korean Stroke Society.",

year = "2019",

month = sep,

doi = "10.5853/jos.2019.01277",

language = "English",

volume = "21",

pages = "340--346",

journal = "Stroke",

issn = "2287-6391",

publisher = "Lippincott Williams & Wilkins",

number = "3",

}

Kammen, MSV, Greving, JP, Kuroda, S, Kashiwazaki, D, Morita, A, Shiokawa, Y, Kimura, T, Cognard, C, Januel, AC, Lindgren, A, Koivisto, T, Jääskeläinen, JE, Ronkainen, A, Pyysalo, L, Öhman, J, Rahi, M, Kuhmonen, J, Rinne, J, Leemans, EL, Majoie, CB, Vandertop, WP, Verbaan, D, Roos, YBWEM, Berg, RVD, Boogaarts, HD, Moudrous, W, Wijngaard, IRVD, Hove, LT, Teo, M, George, EJS, Hackenberg, KAM, Abdulazim, A, Etminan, N, Rinkel, GJE & Vergouwen, MDI 2019, 'External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk', Stroke, vol. 21, no. 3, pp. 340-346. https://doi.org/10.5853/jos.2019.01277

TY - JOUR

T1 - External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk

AU - Kammen, Mayte Sánchez van

AU - Greving, Jacoba P

AU - Kuroda, Satoshi

AU - Kashiwazaki, Daina

AU - Morita, Akio

AU - Shiokawa, Yoshiaki

AU - Kimura, Toshikazu

AU - Cognard, Christophe

AU - Januel, Anne C

AU - Lindgren, Antti

AU - Koivisto, Timo

AU - Jääskeläinen, Juha E

AU - Ronkainen, Antti

AU - Pyysalo, Liisa

AU - Öhman, Juha

AU - Rahi, Melissa

AU - Kuhmonen, Johanna

AU - Rinne, Jaakko

AU - Leemans, Eva L

AU - Majoie, Charles B

AU - Vandertop, W Peter

AU - Verbaan, Dagmar

AU - Roos, Yvo B W E M

AU - Berg, René van den

AU - Boogaarts, Hieronymus D

AU - Moudrous, Walid

AU - Wijngaard, Ido R van den

AU - Hove, Laura Ten

AU - Teo, Mario

AU - George, Edward J St

AU - Hackenberg, Katharina A M

AU - Abdulazim, Amr

AU - Etminan, Nima

AU - Rinkel, Gabriël J E

AU - Vergouwen, Mervyn D I

PY - 2019/9

Y1 - 2019/9

N2 - 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.CONCLUSION: s 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.

AB - 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.CONCLUSION: s 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.

KW - Aneurysm growth

KW - Model validation

KW - Prevention

KW - Risk factors

KW - Subarachnoid hemorrhage

KW - Unruptured intracranial aneurysm

U2 - 10.5853/jos.2019.01277

DO - 10.5853/jos.2019.01277

M3 - Article

C2 - 31590478

SN - 2287-6391

VL - 21

SP - 340

EP - 346

JO - Stroke

JF - Stroke

IS - 3

ER -

External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk

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Keywords

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