Abstract TMP94: Health Inequity And Time From Stroke Onset To Arrival Trends: A Single-centre Experience
Bibliographic record
Abstract
Introduction: Clinical outcomes post childhood stroke have been shown to largely depend on age at the time of stroke, and the size and location of the infarct. However, the impact of health inequities on time to hospital arrival and outcomes remain inadequately addressed. This study examined trends in material deprivation and its impact on time from stroke onset to arrival in the ER for children with arterial ischemic stroke. Methods: A consecutive cohort of children >28 days-18 years of age diagnosed with arterial ischemic stroke between 2004 and 2019 at a comprehensive stroke centre were included. The Ontario Marginalization Index data for each child was derived from their residential postal code using validated mapping techniques. Within the index, material deprivation measures the income, education, single-parent families, and housing quality in a region. Patients were stratified into 3 cohorts by year of presentation; Cohort 1: 2004-2008, Cohort 2: 2009-2013, and Cohort 3: 2014-2019, while their postal codes were dichotomized into low or highly deprived neighbourhoods. The time from stroke onset to arrival was stratified into < 6 hours, 6 to 24 hours, and > 24 hours. Results: Amongst 285 children, more lived in a highly deprived neighbourhood in the later cohort (Cohort 3: 2014-2019) than the earlier cohort (Cohort 1: 2004-2008) (47.5% vs. 40.3%). Compared to Cohort 1, more patients in Cohort 3 arrived in the ER within 6 hours of stroke onset (28.3% vs 52.5%) while a similar trend was found in patients arriving 6 to 24 hours post onset of stroke (10.1% vs. 23.2%). From Cohorts 1 to 3, a significant increase in the proportion of patients arriving in the ER within 6 hours of stroke onset was found (χ 2 = 10.9, p = 0.027). Conclusion: Our study demonstrated an increasing trend toward more patients with stroke coming from highly deprived neighbourhoods. This is a cause for concern. However, whether this has an impact on stroke severity and outcomes is yet to be determined. Over the same period, more patients within the later cohort arrived in the ER within 6 hours of stroke onset. These findings may be attributed to sustained community-based education and primary-care initiatives that have led to increased awareness of childhood stroke symptoms over the past 15 years.
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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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".