P-023 Spoke-administered intravenous alteplase and outcomes for large vessel occlusion stroke patients in a hub-and-spoke telestroke model
Notice bibliographique
Résumé
Introduction The role of intravenous alteplase treatment for emergent large vessel occlusion (ELVO) stroke patients who ultimately undergo endovascular thrombectomy (EVT) has been questioned in recent randomized trials. However, most patients enrolled in these trials presented directly to an EVT-capable hub center (i.e. ‘mothership’ model). We aimed to compare outcomes for ELVO patients transferred to our hub for EVT consideration who were administered alteplase at spoke hospitals (i.e. ‘drip and ship’ model) versus those who were not. Methods ELVO stroke patients who presented to 25 spoke hospitals from January 1, 2018 to June 30, 2020 were retrospectively identified from a prospectively maintained database. Inclusion criteria were transfer for EVT consideration, spoke hospital CTA-defined ELVO, and spoke hospital Alberta stroke program early CT score (ASPECTS) ≥6. ELVO was defined as occlusion of the internal carotid artery terminus, first or second segment of the middle cerebral artery, or basilar artery. Outcomes of interest included adequate reperfusion (TICI 2b-3), any intracerebral hemorrhage (ICH), hub discharge functional independence (modified Rankin scale, mRS ≤2), and 90-day mRS ≤2. Results Inclusion criteria were met for 258 patients. Their median age was 70 years (IQR 60-81), median NIHS stroke scale (NIHSS) was 13 (6-19), and 50% were female. 38% were treated with alteplase at spoke hospitals, and there were no significant differences in baseline characteristics comparing those treated and those not treated except for last known well-to-Telestroke consult time (median 1.6 vs 6.7 hours, p<0.0001). 44% ultimately underwent EVT at the hub with 87% achieving TICI 2b-3. Spoke-administered alteplase was not associated with ICH (OR=1.042, 95%CI=0.390,2.784, p=0.935) and trended toward association with greater TICI 2b-3 (OR=3.589, 95%CI=0.940,13.70, p=0.062). Spoke-administered alteplase independently increased the odds of discharge mRS ≤2 (aOR=2.568, 95%CI=1.159,5.686, p=0.020) and 90-day mRS ≤2 (aOR=3.307, 95%CI=1.591,6.874, p=0.001), even when controlling for last known well, NIHSS, and EVT in multivariable models. Conclusion In this cohort of 258 patients who first presented to spoke hospitals as potential EVT candidates with CTA-defined ELVO and ASPECTS ≥6, treatment with intravenous alteplase at spoke hospitals before transfer significantly increased the odds of discharge and 90-day functional independence without increasing the odds of ICH. Intravenous alteplase should not be withheld from ELVO patients who first present to spoke hospitals capable of its administration but requiring transfer for EVT. Additional studies are warranted to confirm benefits of spoke-administered alteplase in other hub-and-spoke models and to understand the minimum distance and transfer time associated with benefit. Disclosures R. Regenhardt: None. J. Rosenthal: None. A. Awad: None. N. Nolan: None. J. McIntyre: None. C. Whitney: None. N. Alotaibi: None. J. Vranic: None. C. Stapleton: None. A. Patel: None. N. Rost: None. L. Schwamm: None. T. Leslie-Mazwi: None.
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 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
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 ».