Abstract 155: What Predicts Symptomatic Intracranial Hemorrhage in Ischemic Stroke Patients Undergoing Emergent Brain Imaging for Neurological Deterioration After IV tPA?
Bibliographic record
Abstract
Background: Early neurological deterioration (END) prompting urgent brain imaging occurs in up to 15% of ischemic stroke patients receiving intravenous tissue plasminogen activator (tPA). Most of these are not related to symptomatic intracranial hemorrhage (sICH) but lead to unnecessary interruption of the tPA infusion. We aim to determine predictors of sICH in ischemic stroke patients undergoing emergent brain imaging after tPA. Methods: We queried our prospective stroke database and included all patients who received tPA for ischemic stroke from March 1 st , 2015 until March 1 st , 2017. We then identified patients who underwent emergent brain imaging before the planned 24-hour brain imaging and divided these patients into: sICH+ and sICH- defined by NINDS criteria. We compared baseline clinical factors, pre-admission medications, admission blood pressure, symptoms prompting repeat scan [change in level of consciousness (LOC); worsening or new (W/N) neurological symptoms without change in LOC; headache/nausea/vomiting), thrombectomy, 24-hour NIHSS and 90 day outcome. Results: We identified 511 patients who received tPA (sICH rate 4.1%). Emergent repeat brain CT was performed on 108 (21.1%); 17.5% (19/108) had sICH and 21.3% (23/108) occurred during the tPA infusion with only one being related to sICH. The mean time from tPA infusion to symptoms prompting brain imaging in sICH was 7.3 ± 5.3 hours. In patients who underwent emergent brain imaging, sICH+ patients were older (80.2 ± 15.8 vs. 70.8 ± 15.4, p = 0.026), with higher admission NIHSS (14 vs. 7, p = 0.0016) and 90-day mortality (87.5% vs. 22.4%, p<0.001), more likely to have a change in LOC (78.9% vs. 21.3%, p<0.001) and less likely to have W/N symptoms without LOC change (5.3% vs. 42.7%, p=0.002). On multivariable analyses, the only predictor of sICH was LOC change (OR 6.62 95% CI 1.64-26.70, p=0.008). Conclusion: Nearly 95% of patients with ischemic stroke had unnecessary interruption of the tPA infusion for new symptoms shortly after the tPA infusion. A change in LOC was the only predictor of sICH among tPA patients undergoing emergent brain imaging. In this group of patients, the preparation of tPA reversal agents awaiting brain imaging may help reduce tPA reversal times and improve outcomes
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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 | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| 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".