Abstract WP56: 2021 Comparison Of International Stroke Guidelines For Acute Ischemic Stroke
Bibliographic record
Abstract
Background: Many countries/regions have formal Acute Ischemic Stroke (AIS) management guidelines. Variations between guidelines may showcase differences in demographic epidemiology and practice that correspond to the regional or national priorities. Methods: We systemically searched for guideline recommendations on AIS management published between January 1, 2004, and August 20, 2021. With only the latest guideline for each country selected, 11 guidelines from countries/regions of the world were identified and reviewed: United States (2018), Japan (2013), Europe (2018), Australia (2012), Brazil (2012), China (2019), Korea (2019), Canada (2018), India (2011), South Africa (2010), and Malaysia (2006). Results: Urgent imaging guidelines, such as CT or MRI, for initial evaluation are similar across countries; nevertheless, initial intravascular imaging guidelines greatly differ. Of the eleven countries reviewed, the majority recommend a standard tPA dose of 0.9mg/kg, while Japan and China recommend a lower tPA dose of 0.6mg/kg in select patients. While time to initiation of aspirin (ASA) post IV thrombolysis is widely accepted, consensus on the appropriate ASA dose, and possible addition of other antiplatelet therapies does not exist. Mechanical thrombectomy is overall endorsed within 6 hours or between 6-16 hours of symptom onset with causative occlusion, but countries such China and Canada have found validity extending the timeframe to 24hrs and beyond, using imaging modality recommendations. Inpatient management of nutrition, DVT prophylaxis, and rehabilitation differ between the various guidelines. Conclusion: Variations between guidelines exist that highlights those components with a lack of an evidence-based consensus. With further international collaboration, reconciliation of guidelines between countries or regions may be achievable.
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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 | 0.026 | 0.136 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.017 | 0.017 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.010 | 0.003 |
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".