E-133 Adherence to endovascular treatment guidelines in acute ischemic stroke: insights from an international multidisciplinary survey
Bibliographic record
Abstract
Background Several randomized controlled trials have provided level IA evidence for the efficiency of endovascular therapy in acute ischemic stroke. We assessed the adherence to current endovascular treatment guidelines in acute ischemic stroke according to geographical region, hospital setting, medical specialty and physicians’ characteristics. Methods An international cross-sectional survey of stroke physicians and interventionalists was conducted to understand their current practice and therapy decision-making in acute stroke. Participants were randomly assigned 10 cases out of a pool of 22 scenarios and asked how they would treat the patient. Adherence to the 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke From the American Stroke Association was analyzed, and subgroup analyses were performed for different geographical regions, hospital settings, medical subspecialty, physician experience and age. Results 607 physicians (53.6% neurologists, 28.7% interventionalists, 13.3% neurosurgeons, 4.7% other) from 38 countries participated in this survey. Overall guideline adherence in cases based on level of evidence 1A and 2B was 86.1% and 66.6%. For level 1A case scenarios, adherence differed significantly across different specialties (ranging from 90.4% to 56.5%, p<0.001) and different geographic regions (ranging from 89.9% to 72.0%, p<0.001). Physicians with a higher adherence to treatment guidelines performed significantly more EVT cases per year than those with a lower adherence (median 30, IQR 35 vs. 15, IQR 25, p<0.001). In level 2B scenarios, the overall decision rate in favor of EVT was lower (66.6%) and the differences in decision rates between different specialties (73.7% - 40%, p<0.001) and regions (73.9% - 47.1%, p<0.001) were more pronounced. Again, physicians opting for EVT performed significantly more EVTs per year (median 30, IQR 30 vs. 20, IQR 30, p<0.001). Conclusion The high overall adherence to current endovascular stroke treatment guidelines suggests strong consensus within the neurointerventional community. Physician caseload played an important role in our sample. Disclosures J. Ospel: None. N. Kashani: None. A. Wilson: None. W. Kunz: None. P. Sylaia: None. B. Baxter: None. B. Campbell: None. U. Fischer: None. A. Rabinstein: None. S. Yoshimura: None. J. Heo: None. B. Kim: None. M. Cherian: None. F. Turjman: None. M. Foss: None. B. Menon:None. G. Saposnik: None. M. Hill: None. M. Goyal: None. M. Almekhlafi: 1; C; unrestricted research grant by Stryker to the University of Calgary.
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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 | 0.004 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 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".