Abstract T MP56: Challenges in Telethrombolysis: Is Underestimation of Early Ischemic Changes by Stroke Neurologists Associated With Symptomatic Intracranial Hemorrhage?
Bibliographic record
Abstract
Background: The Stroke Eastern Saxony Network (SOS-NET) provides telemedical consultations for patients with acute ischemic stroke. Stroke neurologists recommend intravenous (IV) thrombolysis based on cerebral CT scan evaluation with the Alberta Stroke Program Early CT score (ASPECTS). We sought to assess whether: 1) underestimation of early ischemic changes (EIC) was associated with symptomatic intracranial hemorrhage (sICH); 2) whether high ASPECTS predicted favorable outcome after telethrombolysis. Methods: We retrospectively analyzed prospectively collected data of SOS-NET patients who received IV telethrombolysis from 10/08 to 07/12. Two experienced neuroradiologists re-evaluated cerebral CT scans blinded to clinical findings providing reference standard. We defined underestimation of EIC by stroke neurologists as ASPECTS deviations > +1 point and favorable outcome as modified Rankin scale (mRs) scores of 0 to 2 at discharge. We analyzed whether underestimation of EIC was associated with sICH by ECASS-2 criteria and whether ASPECTS dichotomized at 8-10 versus 0-7 was associated with favorable outcome. Results: Of 647 patients who received IV telethrombolysis during the study term, clinical and imaging data were available for 344 patients (median age 76 [IQR 70 - 81] years, NIHSS score 11.5 [IQR 6 - 18], 54.8% female, onset-to-treatment-time 143 minutes [IQR 110 - 190]). At discharge, 91 patients (27.2%) had a favorable outcome. Overall 14 patients (4.2%) suffered thrombolysis-related sICH. Compared to reference, stroke neurologists underestimated EIC extent in 30 patients (9%). ASPECTS deviations were not associated with thrombolysis-related sICH (3.3% vs. 4.3%; p=1.0). Patients with higher ASPECTS (n=299) were more likely to have a favorable outcome than patients with low ASPECTS (n=35) (35.3% vs. 10.3%; p=0.006). Conclusion: Underestimation of EIC by stroke neurologists was rare and not associated with thrombolysis-related sICH in our telestroke network. ASPECTS of 8 - 10 on pretreatment CT is associated with favorable clinical outcome following telethrombolysis.
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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 | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".