Abstract WP124: Practice Variation in the Management of Aneurysmal Subarachnoid Hemorrhage- A Survey of US and Canadian Emergency Medicine Physicians
Bibliographic record
Abstract
Introduction: To rule out sub-arachnoid hemorrhage (SAH) national guidelines for emergency physicians recommends obtaining a non-contrast CT scan and, if negative, a lumbar puncture. However, anecdotal evidence suggests recent adoption of CT non-contrast alone in patients presenting within six hours from symptom onset and an increase in the use of a newer imaging modality, CT angiogram (CTA). Our aim was to examine emergency physicians’ diagnostic approach to SAH diagnosis and their adherence to the current guidelines. Method: We developed, validated, and distributed a survey to emergency physicians at three different emergency departments: Site 1) Stanford Healthcare, California, 2) Intermountain Healthcare, Utah, and 3) The Ottawa Hospital, Ottawa, Ontario. We surveyed emergency physicians with questions on test performance for SAH detection and case based scenarios to assess adherence to guidelines. Results were presented as proportions with 95% CIs. Results: Of the 216 physicians surveyed, we received 168 responses (77.8%). The responses by site were: 1) (n= 38, 23.2%), 2) (n=70, 42.7%), 3) (n=56, 34.1%). Most physicians indicated that non-contrast CT imaging within a 6-hour window detects >90% of SAH in those with a confirmed SAH [n=150 ( 89.3%, 95%CI 83.6 - 93.5)]. In response to the case based scenarios, a majority of the physicians indicated that they would use a non-contrast CT with an additional CTA [n=110 ( 65.5%, 95%CI 57.8- 72.6)], some indicated an additional LP [n=57 (33.9%, 95%CI 26.8 - 41.6)], and a few indicated both an additional CTA and LP[n=16 (9.5%, 95%CI 5.5-15.0)]. We also observed practice site variation in the proportion of physicians who indicated that they would use CTA: 1) (n=25/38, 65.8%), 2) (n= 54/70, 77.1%), and 3) (n=28/56, 50.0%) (p= 0.006). Conclusion: Survey responses indicated a significant variation in the emergency physicians’ use of diagnostic imaging for SAH and divergence from current guidelines. In our future studies, we will explore the reasons for the practice variation and increasing use of CTA as a diagnostic modality in SAH evaluation.
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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 | 0.003 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".