Abstract TP407: Comparative Characteristics of Ischemic and Hemorrhagic Early Neurological Deterioration Following Intravenous Thrombolysis
Bibliographic record
Abstract
Background: Early neurological deterioration (END) caused by ischemic or hemorrhagic insult following intravenous recombinant tissue plasminogen activator (rt-PA) is a serious clinical event. We aimed to clarify differences in characteristics of END between due to ischemic and hemorrhagic insults. Methods: From October 2005 to December 2015, consecutive patients who received 0.6 mg/kg intravenous rt-PA for acute ischemic stroke was retrospectively registered from 4 affiliated hospitals with a stroke unit. END was defined as any ≥4 point deterioration on the National Institutes of Health Stroke Scale (NIHSS) score compared with baseline within 24 hours. Ischemic lesions were assessed by Alberta Stroke Program Early CT Score (ASPECTS) on the initial CT and/or diffusion weighted imaging (DWI) and the extensive ischemic lesions were defined as ASPECTS ≤ 6 on CT or ≤ 7 on DWI at baseline. Large artery occlusions were defined as occlusions of one or more of the internal carotid artery, proximal portion of the middle cerebral artery, or the basilar artery. END was classified into those due to ischemic (END i ) or hemorrhagic (END h ) insults based on the imaging at deterioration. In comparison with the non-END, factors associated with END i and END h were investigated. Results: A total of 744 patients (452 men, 73.3 ± 12.3 years old) were included. Among them, END was seen in 78 patients (10.5%) including 57 END i (7.7%) and 21 END h (2.8%). END occurred median 7 hours after the administration of rt-PA and most of them occurred within first 2 hours. Comparing to the non-END, multivariate analysis showed that extensive ischemic lesions (Odds ratio [OR] 3.24, 95% confidence interval [CI] 1.57-6.59) and large artery occlusions (OR 3.09, 95% CI 1.54-6.54) were associated with END i , while extensive ischemic lesions (OR 3.49, 95% CI 1.16-10.11), higher baseline NIHSS score (OR 1.07, 95% CI 1.00-1.14), and pretreatment of antiplatelets (OR 3.02, 95% CI 1.08-8.88) were associated with END h . Conclusions: END was an uncommon complication in patients receiving intravenous rt-PA for acute ischemic stroke. END i was approximately three times more than END h . Distinct factors were associated with END i and END h .
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".