Abstract WP220: Onset to Needle Times Differ in Patients with Varying Stroke Severity: A Retrospective Review of a National Stroke Audit
Bibliographic record
Abstract
Introduction: Outcomes following stroke thrombolysis have been observed to be largely dependent on time to treatment. Patients with more severe strokes have more obvious symptoms and are easily diagnosed while patients with milder strokes are often in a grey area where misdiagnosis (particularly as resolving TIA) is common, therefore leading to delayed thrombolysis. Time to treatments are not only influenced by in-hospital factors, but pre-hospital factors as well. Delaying treatment in minor stroke patients might have detrimental effects and diminish chances of good outcome. We wished to examine the effects of stroke severity on onset to needle times (OTN) and door to needle times (DTN) using a national stroke data set. Methods: A retrospective analysis was done on patients who were eligible for and treated with recombinant tissue-type plasminogen activator (rt-PA). Data for all patients in Scotland treated with alteplase between 2010 and 2013 was available from the Scottish Stroke Care Audit (SSCA). Components of the thrombolysis service delivery pathway was compared between minor (NIHSS score of ≤5) and more severe stroke (NIHSS score of ≥6) patients. Results: OTNs and DTNs are both negatively correlated to pre-treatment NIH scores. However, OTN shows greater correlation to pre-treatment NIH scores (r=-0.212 p<001) than did DTN (r=-0.057, p=0.021). Minor stroke patients have longer onset to admission times (105.5 vs. 83 minutes; p<0.001), OTNs (180 vs. 160 minutes; p<0.001), admission to scan times (37 vs. 31 minutes; p=0.004), and were younger (71.22 vs. 74.18 years; p<0.001). Conclusion: This study confirms evidence that minor stroke patients are experiencing delayed thrombolysis, which could reduce the opportunity for benefit for stroke survivors. The reasons for this delay appear to include pre-hospital stroke recognition and response, and also in-hospital patient/clinician decision making as the risks and benefits may be viewed differently in milder strokes. Stroke care guidelines could consider using OTNs as a stroke care standard instead of DTNs in future reviews of management standards.
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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 | 0.012 | 0.041 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.010 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".