Abstract WP407: Cohort Study Examining the Association Between Timely Carotid Revascularization and Key Health System Strategies Among Patients With Transient Ischemic Attack and Stroke
Bibliographic record
Abstract
International guidelines recommend carotid revascularization within 14 days for symptomatic patients. However, significant delays in care persist, with only 9% of outpatients, and 36% of inpatients in Ontario meeting this target. The purpose of this study was to explore the influence of health system factors on carotid revascularization timelines. We conducted a retrospective chart review of all patients undergoing carotid revascularization (endarterectomy or stenting) at The Ottawa Hospital for a symptomatic TIA/stroke event between 2015 and 2016. The primary outcome was time from TIA/stroke event to carotid revascularization. Health system variables of interest included location of patient presentation (outpatient vs emergency department), event onset to presentation time, event onset to vascular imaging time, and same-day collaboration between key services such as emergency providers, radiology, neurology and surgical teams. We used descriptive statistics and univariate analysis to determine statistically significant differences between groups. A total of 228 records were eligible for inclusion. The median time in days from TIA/stroke event to carotid revascularization was 10 days, with 58% of patients having their procedure within 14 days. Prompt patient presentation to an emergency department was associated with significantly shorter timelines to surgery (7 days, p<.001). Early vascular imaging was strongly correlated with early revascularization (4-5 days, p<.001). In addition, collaboration from two or more care services resulted in enhanced timelines to surgery ranging from 2 to 6.5 days (p<.001-.008). We identified several health system strategies that significantly improved achievement of the best practice recommendation of revascularization within 14 days. This included early patient recognition and presentation to emergency services, which emphasizes the need for public awareness. In addition early vascular imaging was strongly correlated with revascularization timelines, suggesting protocols for rapid investigation of these high risk patients is needed both in Emergency and outpatient settings. Direct, same-day communication between services also promoted expedited revascularization.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| 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".