Thread by @AnassBenomarMD

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#Newpub #Hotofthepress : A concrete application of our recent paper stressing the importance of assessing reliability of trial outcomes: validation of the simplified mRS for treated brain aneurysm pts!
lnkd.in/guqziccC

#Tweetorial #RadRes #NeuroTwitter #RadTwitter

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What previous paper, you say? In case you missed it, please check out why evaluating reliability for RCT outcome measures is as important as for diagnostic tests, if not more:
lnkd.in/g4piwx6T

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As everyone knows, mRS is widely used for evaluating functional outcome in stroke pts.

A simplified version (smRS) was proposed by Bruno et al. for easier adjudication.

While reliability was extensively studied for stroke pts, it wasn't for patients with treated aneurysms.

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Moreover, mRS assessment in RCTs is usually only performed by certified stroke neurologists, which can be costly and of limited availability.

Expanding mRS evaluation to non-trained/certified staff could allow for a wider & more effective use & center recruitment.

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We first did a sys review of all Kappa studies of RS showing:

- 7 modif. to initial RS
- Almost all studies were for disab. after stroke
- Higher K ➡️ Ranking Foc. Assessment (RFA) : 0.99
- Lower K ➡️ standard mRS: 0.25
- NO paper assessing mRS reliability after aneurysm Tx

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Inter-rater reliability of smRS was then evaluated between:

1. Vascular Neurosurgeon 🔪🩸
2. Certified Stroke Neurologist 🧠
3. Novice Research Assistant 🙋‍♀️

For 60 patients with clipped📎 or coiled🧶 intracranial aneurysms🎈 from two ongoing RCTs (CURES & ISAT-2).

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Almost perfect inter-rater agreement (K>0.8) was reached for all pairs of raters, as well as overall.

Intra-rater was also >0.8.

High level of reliability was maintained when good outcome was defined as smRS=0-2 (K=0.87), but NOT when defined as smRS=0-1 (K=0.59).

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Moreover:

Significant difference (P=0.003) in smRS adjudication of good outcome between raters was found when smRS 0-1, while not the case when smRS 0-2 (P=0.52).

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That's it! a few take-home points:

1. smRS is a RELIABLE tool for assessing disability in patients with treated brain aneurysms.

2. Defining good outcome as smRS 0-2 is both more reliable AND clinically relevant.

3. Non-trained staff can RELIABLY perform smRS assessments.

Thanks for reading!

Link to full-text: lnkd.in/guqziccC