Abstract 201: Increased Frequency of Early Dispensed but Unused Tpa Shortens Door to Needle Times in Potentially Eligible Thrombolysis Patients Presenting to a Tertiary Stroke Center
Bibliographic record
Abstract
Introduction: Door to needle time (DTN) is an important factor in determining patient outcomes after tPA, and varies widely across hospitals. We sought to determine if early dispensing of tPA in likely eligible patients further would shorten DTN times below 60 min, as suggested by the AHA Target Stroke Phase 2. Methods: Using our hospital’s GWTG-Stroke database we selected patients over 7 yrs (2007-Q2 through 2014-Q2) who presented within 4 hours of last known well and had a vial of tPA dispensed from the pharmacy. A “tPA return rate” was calculated as the proportion of these cases with tPA dispensed in whom it was not administered, and reported per quarter. Median DTN time and tPA return rate were displayed graphically by quarter and their association compared by Pearson’s r. A partial correlation, controlling for NIHSS, was also performed. Results: A total of 382 patients had tPA dispensed, and 143 (37.4%) of those had tPA returned unused. The tPA return rate increased over time and DTN decreased (Figure 1). The tPA return rate was negatively correlated with the median DTN time per quarter (R2 = 0.18, p =0.01) (Figure 2). When additionally controlling for median NIHSS per quarter, the correlation became weaker but remained significant (R2 = 0.14, p=0.03). Conclusion: Implementing a strategy of early dispensing of tPA for potentially eligible stroke patients was correlated with significant reductions in DTN times, with median DTN times per quarter consistently below 45 min in the final year. Our data remained significant even after adjusting for stroke severity. These data support the use of the early dispensing strategy recommended by Target Stroke to further reduce DTN times. Further research is warranted to confirm these findings.
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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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| 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".