Abstract W P282: Delays in Presentation to Stroke Prevention Clinic after TIA or Minor Stroke are Associated with Increased Recurrent Events, Hospitalization and Mortality
Notice bibliographique
Résumé
Background: Prompt assessment in a stroke prevention clinic (SPC) reduces the risk of recurrent stroke after transient ischemic attack (TIA) or minor stroke. However, not all patients are seen rapidly, even in high-risk TIAs with speech deficits or unilateral weakness. The effects of delays on patient outcomes are not clear. We examined the records of patients referred after TIA/minor stroke to determine frequency, degree and reasons for delays in evaluation and carotid revascularization, as well as the effect of delays on patient outcomes. Methods: Records were obtained for all referrals to a regional SPC over 3 years. Target times were based upon triage symptoms, with highest-risk patients (unilateral weakness/speech deficits) being seen 2 days from receipt of referral, moderate-to-high risk within 7 days, and others within 30 days. Data regarding presentation, triage/referral, appointment, investigations and carotid revascularization were obtained. Delays between time points were calculated, and delay reasons were adjudicated. 90-day outcomes including death, recurrent stroke/TIA, and hospital readmission were determined, and comparisons made between patients with and without assessment delays. Results: Between 2009-11, 3492 patients were referred. 1420 (35.8%) were seen beyond suggested dates; the most common reason was scheduling issues (74.2%) followed by patient cancellation (7.9%) and hospitalization (6.0%). The average delay was 2.63 days (SD 7.48), increasing to 3.75 days (SD 5.35) in highest-risk patients. 79 (2.26%) patients had carotid revascularization; of these, 71 (90%) had surgery more than two weeks after onset. Delays were most often due to logistical issues (42.3%). Overall, assessment delays were associated with an absolute increase of 3.7% in 90-day hospitalization (p=0.001), 2.0% in recurrent stroke/TIA (p=0.013) and 0.8% in mortality (p=0.013). Conclusions: Delays in assessment after TIA/minor stroke are common and often due to potentially preventable system factors. These delays are associated with an increased absolute risk of recurrent stroke/TIA, hospitalization, and death. Avoiding delays between referral and assessment may provide opportunities to reduce adverse outcomes in this population.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».