Abstract P35: Mild or Improving Stroke is the Most Frequently Documented Reason for Not Giving rt-PA in Time-Eligible Acute Ischemic Stroke Patients: Findings From Get With the Guidelines-Stroke
Bibliographic record
Abstract
Introduction: Previous studies suggest that mild or improving stroke is a frequently cited reason for not giving IV rt-PA and that some of these patients have poor outcomes. Methods: We examined the frequency of rt-PA use and contraindications among acute ischemic stroke patients arriving ≤2 hrs in the Get With The Guidelines-Stroke Program. Results: Between 4/1/2003-9/29/2009 there were 98,708 patients who arrived directly to the hospital within 2 hours. Among these patients 26.4% received IV rt-PA, 30.9% did not receive rt-PA solely because of mild/improving stroke, 28.6% had other contraindications, and 14.1% had no documented contraindications. From 2003-2009 rtPA use increased, the proportions not given rtPA despite no documented contraindications decreased, and the proportions with mild/improving stroke or other contraindications were similar (Figure). The initial NIH Stroke Scale (NIHSS) was recorded in 62.1% with mild/improving stroke and 82.3% given rt-PA; 75% of mild/improving stroke patients had NIHSS <5 while 90% of IV rt-PA-treated patients had NIHSS ≥5. Short-term outcomes in patients with mild/improving stroke were not always good: 1.1% died, 0.7% were discharged to hospice, 10.3% to a skilled nursing facility and 15.1% to an inpatient rehabilitation facility. Conclusion: In this large national study, mild/improving stroke is the most common reason for not giving rt-PA to early arriving patients. More patients are excluded because of mild/improving stroke than are treated with rt-PA. When deciding whether to withhold thrombolysis in patients with mild/improving stroke, clinicians should consider the risk of poor outcomes in this population.
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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 | 0.002 | 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".