Abstract TP338: Process Improvement Retrospective Review: Hyperglycemia Treatment after Stroke and Subsequent Hypoglycemia
Bibliographic record
Abstract
Background and Purpose: Admission blood glucose in stroke patients has been proven to be an independent predictor of disability and short term mortality. Hyperglycemia has been shown to have an association with infarct volume expansion in ischemic stroke patients. Euglycemia is often achieved through the use of an intravenous insulin drip. Current guidelines caution against the use of D5W as the excess free water may exacerbate cerebral edema; rather, normal saline is preferred. The use of IV insulin with normal saline or other non-dextrose containing IV fluids without enteral nutrition has been the subject of concern for increased hypoglycemic episodes. Methods: Single center review of all patients admitted for all types acute stroke from May 1 st , 2011 to April 27 th , 2012 who were subsequently placed on an IV insulin drip at any time during hospitalization (n=97). Retrospective review of all hypoglycemic episodes (<70mg/dL), IV maintenance fluids, and nutrition (tube feeding, oral diet, TPN) during the course of hospitalization was conducted. Results: A total of 97 stroke patients on IV insulin were identified; 20 (20.6%) were excluded due to alternately receiving dextrose and non-dextrose containing fluids; 65 (67%) did not receive any IV fluids containing dextrose while on IV insulin; 12 (12.4%) did receive IV fluids containing dextrose. The number of patients who experienced hypoglycemia was not significantly different between groups [5 (7.7%) vs. 0 (0%), p=1.000]. In the 5 patients with hypoglycemic episodes 4 were receiving enteral feeding during these episodes; only 1 patient in the sample (1.3%) was on neither IV dextrose nor enteral nutrition during a hypoglycemic episode. Conclusions: Post-stroke hyperglycemia is safely controlled by IV insulin and non-dextrose containing solutions without significant risk for hypoglycemic episodes.
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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 | 0.005 | 0.023 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.005 | 0.011 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 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".