Trends in Endovascular Therapy and Clinical Outcomes Within the Nationwide Get With The Guidelines-Stroke Registry
Bibliographic record
Abstract
BACKGROUND AND PURPOSE: We sought to determine hospital and patient characteristics associated with the use of endovascular therapy for acute ischemic stroke and to analyze trends in clinical outcome. METHODS: Data were from Get With The Guidelines-Stroke hospitals from April 1, 2003, to June 30, 2013. We looked at trends in number of hospitals providing endovascular therapy, the use of endovascular therapy in these hospitals and clinical outcomes. We analyzed hospital and patient characteristics associated with endovascular therapy use. RESULTS: Of 1087 hospitals, 454 provided endovascular therapy to ≥1 patient in the study period. From 2003 to 2012, proportion of hospitals providing endovascular therapy increased by 1.6% per year (from 12.9% to 28.9%; P<0.0001), with a modest drop to 23.4% in 2013. Utilization of endovascular therapy increased from 0.7% to 2% (P<0.001) with a modest drop to 1.9% in 2013. The overall rate of symptomatic intracerebral hemorrhage among endovascular therapy treated patients was 9.7%. In multivariable analyses, patient outcomes after endovascular therapy improved over time, with reductions in in-hospital mortality (29.6% in 2004 to 16.2% in 2013; P=0.002); and from late 2010, reduction in symptomatic intracerebral hemorrhage (11% in 2010 to 5% in 2013; P<0.0001), increased independent ambulation at discharge (24.5% in 2010 to 33% in 2013; P<0.0001) and discharge home (17.7% in 2010 to 26.1% in 2013; P<0.0001). Trends for these outcomes persist in the analyses adjusted for baseline National Institutes of Health Stroke Scale. CONCLUSION: The use of endovascular therapy increased modestly nationally from 2003 to 2012 and decreased in 2013. Clinical outcomes improved notably from 2010 to 2013, coincident with more experience and newer thrombectomy devices.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 teacher head, 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".