Abstract 219: Determining the Proportion of Patients with Poor Premorbid mRS presenting with Large Volume Stroke
Notice bibliographique
Résumé
Introduction Several lines of evidence demonstrate the effectiveness of endovascular treatment (EVT) for large volume stroke (LVS) as defined by Alberta Stroke Program Early CT Score (ASPECTS) of <6 in decreasing severe disability and death. However EVT cannot improve the degree of disability as measured by modified Rankin Scale to be better than premorbid levels. Despite this limitation, patients with severe disabilities are transferred to acute care facilities for consideration of EVT and are hospitalized resulting in over‐medicalization during a terminal event. We aim to determine the proportion of patients with LVS who have poor premorbid mRS (4‐5) and the number of days this subset spent in hospital prior to palliation/death. Methods 2485 CT angiograms of head and neck and CT Head examinations performed between 2018‐2021 were obtained from the picture archiving and communication system (PACS). Cases presenting with ASPECTS<6 as assigned by a neuroradiologist were identified. Functional outcome data, as defined by mRS, was obtained prior to the acute presenting event (premorbid mRS) and on discharge (outcome mRS). All patients with a documented outcome mRS were included in the analysis. Patients were excluded if presenting ASPECTS was >=6, if stroke symptoms were attributable to etiology other than large vessel or tandem occlusion, or if the studies had been duplicated. Number of days spent hospitalized was calculated based on admission date and discharge date. Further subgroup analysis was performed to compare the cost of hospitalization with return to long term care (LTC) based on the Canadian national average of $7803 for hospitalization and $2406 for long term care as provided by Canadian Institute of Health Information and Ministry of long term care of Ontario. Results From the 2485 examinations, 62 had a baseline ASPECTS<6 and 22 cases met exclusion criteria. 40 cases were available for analysis [premorbid mRS (n): 0=(18), 1=(5), 3=(6), 4=(7), 5=(2), ?=(2); age range: 28‐93; 19 male, 21 female]. 23% (9/40) of patients had premorbid mRS of 4‐5, and of these, 78% (7/9) were from LTC or a retirement home. On average, 5.9 days were spent hospitalized [range 4‐9 days]and $5397/person was spent per hospitalization. Conclusion LVS secondary to a LVO can be an acutely terminal illness. 23% of patients presenting with LVS had a poor premorbid mRS. 78% of these patients resided in long term care centers and spent an average of 5.9 days ($5397/person) being hospitalized prior to their demise/palliation.
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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 | 0,000 | 0,002 |
| 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 | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 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 ».