Should more patients with acute ischaemic stroke receive thrombolytic treatment?
Bibliographic record
Abstract
In developed countries, stroke is the third most common cause of death and the most common cause of dependency in adults. Thrombolysis with recombinant tissue plasminogen activator (rt-PA) was licensed for use in highly selected patients within three hours of acute ischaemic stroke in the United States in 1996 on the basis of the National Institutes of Neurological Disorders and Stroke (NINDS) randomised controlled trial (n=624),1 which showed substantially lower combined rates of death or dependency with this treatment (140/1000 fewer) despite an excess of symptomatic intracranial haemorrhage (60/1000 more). The Cochrane review of all data from randomised trials of rt-PA and a meta-analysis of individual patient data agreed with these findings.2 3 In Europe, a conditional licence for use within three hours in highly selected patients was granted in 2002 on the basis of the NINDS trial plus data from two European randomised controlled trials (n=930).4 5 However, six years after European and 10 years after US licensing, fewer than 10% of eligible patients receive thrombolysis—1-7% in the US,6 7 3% in Canada,8 3% in Germany,9 and 3.3% in Sweden (www.riks-stroke.org)—and use of rt-PA varies greatly between European countries.10 Clinicians and managers are uncertain about how widely to use rt-PA in routine clinical practice.11 The fact that treatment licenses are based on data from fewer than 1000 randomised patients with narrow entry criteria, the substantial excess of symptomatic intracranial haemorrhage, plus the restricted licence conditions may worry many clinicians. In 2009, a systematic review of all randomised trials comparing thrombolysis with control (mostly placebo) in patients with acute ischaemic stroke analysed 26 trials of various thrombolytic drugs, 11 of which tested rt-PA up to six hours after stroke (n=3977) (figure⇓).12 Compared with control, rt-PA given up to six …
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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 | 0.008 | 0.086 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.001 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.008 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.006 | 0.006 |
| Insufficient payload (model declined to judge) | 0.029 | 0.003 |
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".