Delays in the Emergency Department, Medical Complications of Stroke and Predictors of Clinical Outcomes: The McGill Experience (P2.310)
Bibliographic record
Abstract
Background: Canadian Best Practice Stroke Guidelines state that acute stroke patients should be admitted within 4 hours to a stroke unit. The objectives of our study were to assess current delays in our emergency department (ED), medical complications in ED and during stroke unit admission, and predictors of clinical outcomes. Methods: This is a retrospective review of patients (n=353) admitted with ischemic strokes from January 2011 to March 2014 at Montreal General Hospital and Montreal Neurological Hospital. We assessed the length of stay in ED, medical complications in ED and during admission, modified Rankin Scales (mRS) at discharge and survival. Correlation between both functional outcome and survival and risk factors was evaluated using adjusted odds ratios (OR) and standardized B coefficient (β), with associated p values. Results: Delays in ED were 22.5 hours in average with a median of 13.8 hours. The overall rate of medical complications in the ED was 14[percnt], the most common being delirium and urinary tract infection. Complications during admission occur in 46.7[percnt] of stroke patients, with pneumonia, urinary tract infection and delirium being the most common. Worse functional outcome was correlated with increasing age (β=0.2, p<0.01), development of pneumonia during admission (β=0.1, p=0.04) and presence of brain edema during admission (β=0.2,p<0.01). Increased risk of death was correlated with pneumonia in ED (OR=26, p500, p<0.01) and sepsis during admission (OR=27, p=0.01). Conclusions: This preliminary analysis of our cohort reveals that there is a significant delay in the admission of patients from the ED to the stroke unit, and that this delay is not in keeping with current Canadian Stroke Best Practice guidelines. Medical complications were prevalent, and pneumonia, brain edema and sepsis during admission were associated with worse clinical outcomes. Further work will explore the correlation between delays in ED, medical complications and clinical outcomes. Conclusions:
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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 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 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".