Abstract W P282: Delays in Presentation to Stroke Prevention Clinic after TIA or Minor Stroke are Associated with Increased Recurrent Events, Hospitalization and Mortality
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".