Abstract WMP90: Comparison of Acute Ischemic Stroke Care Between Comprehensive Stroke Centers and Primary Stroke Centers Participating in Get With the Guidelines-Stroke
Bibliographic record
Abstract
Background: To improve stroke care, the Brain Attack Coalition recommended establishing primary stroke center (PSC) and comprehensive stroke center (CSC) certification. Achieving CSC designation requires the ability to provide more complex services. However, it remains unknown whether CSCs have better performance than PSCs for ischemic stroke care. This study compared ischemic stroke care between CSCs and PSCs. Methods: The study included consecutive patients who were admitted to the 134 CSCs and 1047 PSCs participating in Get With The Guidelines (GWTG)-Stroke between January 1, 2013 and December 31, 2015 with a final diagnosis of acute ischemic stroke. Multivariable logistic regression models were generated to examine the association between stroke center certification (CSC vs PSC) and performance measures and outcomes, after adjusting for potential confounders including patient and hospital characteristics. Results: Of the 605,136 patients who were admitted directly from the emergency department, 110,624 were admitted to CSCs and 494,512 to PSCs. CSCs were larger than PSCs (median number of beds 481 vs 263). Performance differences between CSCs vs. PSCs are shown in the table. CSCs and PSCs had comparable overall conformity to the seven performance measures represented by the summary defect-free care measure. CSCs outperformed PSCs in several key measures, especially the use of intravenous tissue plasminogen activator (IV tPA) and intra-arterial thrombectomy (IA-therapy). Compared with patients at PSCs, patients at CSCs were more likely to receive IV tPA in both unadjusted and adjusted models. The door to IV tPA time was shorter at CSCs. Patients at CSCs were more likely to receive IA therapy, with shorter door to IA therapy times. Mortality was higher at CSCs. Conclusions: Stroke care at CSCs exceeded PSCs for many but not all quality measures, particularly timely acute reperfusion therapy. Risk adjusted in-hospital mortality was modestly higher at CSCs.
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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 | 0.004 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".