Abstract 83: Therapeutic Hypothermia in Patients With Acute Ischemic Stroke a Systematic Review of Prospective Controlled Studies
Bibliographic record
Abstract
Background: Therapeutic hypothermia (TH) is a potent neuroprotectant in stroke models. We investigated its effects in published studies of ischemic stroke patients. Methods: This is a systematic review and meta-analysis of prospective randomized and non-randomized controlled studies published till July 2018. Full manuscripts reporting the type and outcomes of TH in acute ischemic stroke patients were included. We classified TH into systemic (body cooling) and selective (brain cooling). Two reviewers independently selected eligible studies and extracted the data. The main outcomes were neurological improvement (using the baseline to follow up NIHSS difference), complications, and mortality. Results: Of 2850 retrieved studies, 16 prospective controlled studies (813 patients) were included. Systemic TH was used in 13 studies (8 RCTs, 5 non-randomized parallel- controlled) while selective TH in 2 studies (1 RCT, 1 parallel- controlled), and one RCT used both types. Methods of cooling were highly variable and often multiple modalities were used. Median time from onset to TH start was 6 hours (IQR 7.5). Median target temperature was 33°C (range 32-35), which was reached within a median of 4 hours (IQR 3.7) in 9 systemic TH studies; while only one selective TH study reported the time to target temperature (17 minutes). Selective TH studies did not report enough outcomes to allow comparison with systemic TH. Outcomes are summarized in the forest plot and stratified by the study design (figure). Cardiac complications were higher in the TH vs controls (pooled relative risk “RR” 1.5, 95% CI 1.2 to 1.9, p 0.001). The pooled estimates suggest non-significant higher risks of pneumonia (RR 1.2, 95% CI 0.9 to 1.7, p 0.2) and death (RR 1.1, 95% CI 0.8 to 1.6, p 0.5) with TH. Eight studies reported baseline and follow-up NIHSS. The standardized mean difference was comparable (p = 0.413). Conclusions: TH was associated with complications without improving recovery or mortality rates.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.011 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".