Abstract TP21: Patterns of Stroke Transfers and Predictors for Thrombectomy Post-MR CLEAN: a Single Center Experience
Bibliographic record
Abstract
Introduction: Recent trial data demonstrating benefit of endovascular therapy (EVT) in acute ischemic stroke (AIS) patients has led to increased referrals to stroke centers for consideration of EVT. We aimed to characterize the baseline predictors and patterns of transfer for patients undergoing EVT. Methods: We reviewed data of consecutive AIS patients who were transferred to our institution between 02-to-07/2015 within 6 hours of stroke onset for potential EVT. We compared baseline demographics, vascular risk factors (age, diabetes, hypertension, coronary or carotid disease, atrial fibrillation, anticoagulation use, prior history of stroke/TIA), NIHSS, ASPECTS, time from symptom onset to CT and to tPA infusion, transfer time and presence of large vessel occlusion between patients who underwent EVT versus those who did not upon transfer. Results: Forty-three AIS patients were transferred to our institution within 6h of stroke onset and after treatment with IV tPA at outside hospitals for potential EVT; (age: 30-101, 42% women, 44% underwent EVT). In comparison to patients treated medically, those who underwent EVT had greater frequency of proximal arterial occlusion (95% vs. 38%, p<0.001) and higher baseline NIHSS scores (mean: 17 vs. 9, p<0.001). Although not statistically significant, the EVT group was younger (62 vs. 71 years) and had shorter transfer times (161 vs. 135 min). NIHSS (OR 1.2, 95% CI 1.0-1.5), but not proximal vessel occlusion (OR 6.5, 95% CI 0.5-81.9), independently predicted those who underwent EVT in a multivariable regression analysis. NIHSS was highly discriminatory for individuals undergoing EVT (area under the receiver operating characteristic curve: 0.9, p<0.001), with a NIHSS threshold of 9 having a negative predictive value of 100% and positive predictive value of 66%. Conclusion: In this single center study; NIHSS was the only independent predictor of EVT in AIS transferred within 6 hours of symptom onset. A NIHSS threshold of less than 9 seemed to discriminate patients who did not ultimately undergo EVT at our institution. The limited work-up prior transfer and prolonged transfer time highlights the need for regional and national efforts to maximize the utility and benefit of EVT for AIS patients.
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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".