Abstract 337: Comparing Time to Percutaneous Coronary Intervention in Rural States: Arriving via Ambulance vs Personally Owned Vehicle
Bibliographic record
Abstract
Background: Minnesota, North Dakota and South Dakota continue to build the infrastructure to improve the system of care for patients experiencing a ST-elevation myocardial infarction (STEMI). Time from symptom onset to Percutaneous Coronary Intervention (PCI) is a critical component for better patient outcomes. First responders are critical to the success of an effective STEMI system of care. However, about 52% of STEMI patients in these states are arriving by self-transport or personally owned vehicles instead of activating the system via 911. Ideally, the catheterization lab team would be notified by EMS personnel in the field or by emergency physicians after receiving the transmitted ECG indicating a STEMI and reducing the time to PCI. Methods: In time period, 774 STEMI patients were entered into ACTION Registry-GWTG from Quarter 3 2013 to Quarter 2 2014. The data included STEMI patients from 19 hospitals in Minnesota, North Dakota and South Dakota participating in Mission: Lifeline, an American Heart Association initiative to improve STEMI systems. The patients analyzed arrived directly to a PCI capable hospital. Patients transferred from a referring facility were excluded in time comparison. Arrival mode percentage comparison to first facility is the exception and includes all patients. Results: The median time from patient arrival at PCI center to catheterization lab arrival ranged between 22 and 31 minutes with a mean 26 minutes for patients arriving via EMS. Patients that came by personally owned vehicle had a median time from arrival to catheterization lab that ranged between 35 and 41 minutes with a mean of 38 minutes. The median time from hospital arrival to PCI had a mean of 42 minutes for patients arriving via EMS compared to those arriving via self-transport at 57 minutes. Conclusion: Patients arriving to a PCI hospital via EMS arrive in the catheterization lab and receive PCI faster than those arriving by personally owned vehicle. Thus, in the setting of STEMI, failure to activate EMS prolongs ischemic time.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 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".