Abstract T P310: The Acute Carotid Clinic: A Paradigmatic Shift to Facilitate Reduced Wait Times for Carotid Artery Stenting in Ontario
Bibliographic record
Abstract
Introduction: North American guidelines on stroke prevention recommend carotid artery revascularization for symptomatic carotid disease within 2 weeks of the index event. Achieving this benchmark has proven historically challenging in the context of the universal coverage afforded by the Ontario Health Insurance Plan (OHIP), which is the sole provider of healthcare in Ontario (approximately 13.5 million people). Recent literature has indicated that wait times for carotid revascularization are unacceptably high. We sought to examine how the implementation of a dedicated Acute Carotid Clinic (ACC) in a Canadian academic stroke center would impact this public health dilemma. Methods: Retrospective analysis was preformed on 48 consecutive patients with symptomatic carotid artery disease who underwent endovascular treatment (carotid stenting) via the Acute Carotid Clinic’s expedited evaluation process over a 13-month period (July 2012 to July 2013). All patients were triaged based on direct physician referral with concurrent vascular imaging demonstrating high-grade carotid stenosis in the appropriate vessel. Patients were not placed on wait lists, and seen urgently. Results: The average time from consultation to revascularization was under 1 week (mean time 6.7 days). Historical controls of average wait times in Ontario for Carotid Endartarectomy have been previously published at 25.7 days. The percentage of patients who achieved revascularization within 2 weeks of the index event was 38%. Previously published series from Ontario for Carotid Endartarectomy showed 8 to 30% of patients were revascularized within 2 weeks of the index event. Conclusion: The paradigm of an Acute Carotid Clinic could allow for the rapid triage, assessment, and treatment of symptomatic carotid disease for the 13.5 million residents of Ontario. Adoption of this paradigm by other centers in Ontario could significantly reduce the burden of cerebrovascular disease in the province. Further research and government wide initiatives could be aimed at increasing the awareness of referring physicians to this expedited evaluation process.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 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 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".