Abstract 8: Door-to-Imaging Times in Patients Presenting With Acute Stroke
Bibliographic record
Abstract
Objectives: National guidelines recommend that patients presenting with acute stroke undergo brain imaging within 25 minutes of emergency department arrival. Delays in brain imaging may prevent or reduce effective stroke treatments such as thrombolysis. Methods: Data from the Get With the Guidelines-Stroke program from 2003 through 2009 were analyzed to determine overall imaging rates, temporal trends, and predictive variables associated with door-to-imaging times in patients who presented to an emergency department within 2 hours of stroke symptom onset and did not have clear contraindications to thrombolytic treatment. Multivariable logistic regression adjusting for within-hospital clustering was performed to identify the independent predictors of brain imaging within 25 minutes of emergency department arrival. Results: The study population consisted of 221,538 patients. Brain imaging was performed within 25 minutes in only 21.6% of patients. Rates of brain imaging <25 minutes were low among all stroke subtypes (ischemic stroke 22.1%, subarachnoid hemorrhage 18.7%, intracerebral hemorrhage 28.3%) and remained low but increased slightly from 2003 to 2009 (18.8% to 21.7%). In the multivariable model, the following variables were associated with less likelihood of brain imaging being completed within 25 minutes of arrival: age > 70 years; female gender; African American race; history of diabetes, carotid stenosis, peripheral vascular disease, or smoking; use of antihypertensive or diabetic medications; symptom onset in another acute care or chronic care facility; transportation to hospital other than ambulance; and hospital location in the Northeast region. History of atrial fibrillation/flutter and use of cholesterol-reducing medications were associated with a higher likelihood of brain imaging completed within 25 minutes. Conclusions: In most patients with acute stroke symptoms, brain imaging is not performed within the recommended 25 minutes. Future quality improvement initiatives should focus on reducing door-to-imaging times, with a specific emphasis on the predictive variables identified in this analysis.
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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 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| 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".