Letter to the Editor: Improving arteriovenous malformation research and care
Bibliographic record
Abstract
In this article, the authors reported the functional outcome of patients suffering from aneurysmal subarachnoid hemorrhage (SAH) regarding the timing of surgical exclusion of aneurysms.The data were extracted from a randomized controlled trial conducted for another purpose, and the study comprised 1000 patients. 4 Mahaney and colleagues showed that functional outcomes were better if surgical exclusion was performed early (0-2 days after the initial hemorrhage) or late (7-14 days) rather than intermediately (3-6 days).As we consider the issue of the timing of aneurysm exclusion in SAH of utmost importance, we carefully read this article.We were surprised at the total lack of data concerning preoperative rebleeding, which is a major and known factor of poor outcome, and its incidence is far from anecdotal. 3 In this study, patients were in World Federation of Neurosurgical Societies (WFNS) Grades I-III at the time of surgery; these grades might have been different from those at the time of aneurysm rupture.These criteria might have automatically excluded patients with preoperative rebleeding, as rebleeding in most cases is associated with severe deterioration in neurological status.Therefore, the conclusions of this study could contribute to a significant bias as the study does not include the eventuality of rebleeding as a prognostic factor.This bias may be significant; for example, in the late surgical exclusion group, if we consider the risk of early rebleeding, published in the International Cooperative Study on the Timing of Aneurysm Surgery, about 13% of these patients would have suffered from rebleeding. 1 As these patients should not have a good functional outcome, the percentage of patients with a Glasgow Outcome Scale score of 1 in this group decreased from 67% to 54%.Thus, the results would be similar to those in the intermediate group, and probably really worse than those in the early group, as the risk of preoperative rebleeding in the early group is less important.Therefore, the conclusions of this study are more limited than expected: with equal immediate preoperative clinical grades across all 3 groups, early and late surgical aneurysm exclusion are associated with better outcomes than intermediate exclusion (3-6 days).We also do believe that early aneurysm exclusion in SAH is the best practice, as it decreases the risk of rebleeding and allows for aggressive therapy for vasospasm.This article provides a new argument: very early surgical exclusion almost by itself improves the functional outcome.
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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 | 0.004 | 0.036 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.015 | 0.019 |
| Insufficient payload (model declined to judge) | 0.007 | 0.005 |
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".