Abstract TP305: International Comparison of Patient Characteristics and Performance Measures in Acute Ischemic Stroke: Analysis of the American Heart Association Get With the Guidelines-Stroke Registry and China National Stroke Registry
Bibliographic record
Abstract
Background: Stroke is a key contributor to the global burden of disease and the second leading cause of death worldwide. Efforts to measure and improve care are rapidly extending to low and middle income countries. Yet there is lack of comparative assessment of characteristics and adherence to evidence-based performance measures in acute ischemic stroke for most world regions. Methods: We analyzed data of consecutive acute ischemic stroke patients in the Get With The Guidelines Stroke (n=194,876 from 1548 sites) and the China National Stroke Registry (n=19,604 from 217 sites) between 2012 and 2013. Patient characteristics and adherence to guideline-based performance measure in both countries were compared. Results: Compared with their US counterparts, Chinese patients were much younger (mean 64.8 vs. 70.5 years), had lower prevalence of comorbidities except for prior stroke/TIA and smoking, had less severe stroke (NIHSS, mean 5.4 vs. 6.8) and more delay from symptom onset to arrival (median 22 vs. 11 hours) (all p<.001). Overall, use of intravenous thrombolytic therapy was 2.4% in China (tPA 1.4% and urokinase 1.0%) and 8.1% in US (tPA). Chinese compared with US patients experienced more treatment delay (door-to-needle time, median 95 vs. 62 minutes, p<.001). Adherence to early and discharge antithrombotics, smoking cessation counseling, and dysphagia screening were fairly high in China (>80%), although numerically lower than in the US. The largest differences between performance measure adherence in Chinese and US care were seen in timeliness of tPA treatment, venous thromboembolism prophylaxis, lipid lowering therapy, anticoagulation for atrial fibrillation, and rehabilitation assessment (Figure). Conclusion: We found important differences in clinical characteristics and gaps in adherence to certain performance measures between China and the US. National efforts are needed for continued improvements in acute ischemic stroke care in both countries.
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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 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| 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".