Abstract T P324: Prehospital Neurological Deterioration Predicts Intracerebral Hemorrhage
Bibliographic record
Abstract
Introduction: Elevated hospital admission blood pressure (BP) has been associated with early neurological deterioration (END) in acute stroke patients. We tested the hypothesis that higher prehospital BP is also associated with END. Methods: We conducted a retrospective analysis of a prospectively-maintained centralized database of electronic patient health care reports (ePCR), including serial BP and GCS measurements, of all patients transported by Emergency Transport Services (EMS) to the Emergency Department (ED) of a single hospital during an 18-month period. All patients with an EMS dispatch code for suspected stroke were included. Hospital charts and neuroimaging were utilized to determine final diagnosis of ischemic stroke (IS), intracerebral hemorrhage (ICH), and early death (prior to discharge). END was defined as ≥2 point drop in Glasgow Coma Scale (GCS) score prior to hospital arrival. Results: A total of 877 patients were transported by EMS to the ED with suspected stroke. Of these, 420 patients had a final diagnosis of acute stroke (360 IS, 60 ICH). Mean ± SD prehospital SBP was higher in ICH (172 ± 32 mmHg) than IS patients (155 ± 27 mmHg, p<0.001). Initial median (IQR) GCS was lower in ICH (13(5)) than IS patients (15(2), p=0.001). Prehospital END was more common in ICH (9/60 (14.8%) than IS (2/360 (0.6%), p<0.001). Univariate logistic regression indicated that prehospital END predicted the diagnosis of ICH (OR 5.6 (95% CI: 2.6-12.2)). Mean prehospital SBP was similar in patients with (171 ± 39 mmHg) and without END (158 ± 28 mmHg, p=0.29). SBP change during EMS transport was similar in patients with END (-5 (25) mmHg) than those without (-2 (23) mmHg, p=0.88). Prehospital END was more common in those who died (11.8%) than those who survived (0.8%, p=0.001). Mean prehospital SBP was higher in patients who died (166 ± 35 mmHg) than those who survived (157 ± 7 mmHg, p=0.04). Early death occurred more often in ICH (43%) than IS (12.5%, p<0.001). Conclusion: Prehospital END is predictive of ICH. Although mean prehospital BP was not higher in patients with END in this retrospective study, it was associated with early death, which is supportive of the hypothesis that elevated prehospital BP may be an acute treatment target.
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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 | 0.003 |
| 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 | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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".