Abstract TP336: Influence of Aversion to Uncertainty in STROKE Care
Bibliographic record
Abstract
Introduction: Physicians caring for patients with silent cerebral infarction (SCI) face several diagnostic and therapeutic challenges. In situations with limited information or lack of guidelines, clinical decisions may be influenced by aversion to uncertainty (AU) defined as a tendency to prefer known over unknown risks. Hypothesis: We hypothesize that physicians’ AU is associated with overutilization of diagnostic tests and influences therapeutic choices for patients with covert cerebrovascular disease. Methods: Participating physicians were practicing neurologists with expertise in stroke care identified from WSO, CSC, VasCog and SORCan. Those who agreed to participate were sent an online questionnaire. Participants randomly received 10 cases from a pool of 20 assessing perception of risk for later stroke and treatment preferences, with additional validated questions to quantitatively determine AU, and overconfidence. The questionnaire was completed online. A multivariable analysis was completed adjusting for age, years of experience, and annual volume of stroke patients. Results: Of 252 initial participants, 35 (13.9%) were excluded for incomplete responses. Of 217 remaining participants for the analysis, 50% of participants expressed that uncertainty was troublesome with their diagnosis. AU was associated with greater recommendation of oral anticoagulants for a case-scenario with atrial fibrillation, CHADS 4 and microbleeds (OR 3.26; 95%CI 1.30-8.19), and with ordering more investigations for an asymptomatic cortical infarction (OR 2.61; 95%CI 1.17-5.83). AU was also associated with recommending tPA or endovascular treatment for a 72 year old woman presented within 4 hours with an NIHSS 6-7 and asymptomatic microbleeds, but otherwise no other contraindication (OR 3.32; 95%CI 1.19-9.27). Conclusion: Aversion to uncertainty is common among practicing stroke neurologists. AU was associated with ordering more investigations and more appropriate recommendations for oral anticoagulation or revascularization when indicated. The present study has practical implications, as aversion to uncertainty may be associated with a more vigilant practice.
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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 | 0.003 | 0.031 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.010 | 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".