Abstract WP69: Days Alive And Out Of Hospital As A Measure Of Stroke Outcome In Patients Receiving Hyperacute Stroke Intervention
Bibliographic record
Abstract
Background: Patient outcome after stroke is frequently assessed with the modified Rankin Scale score (mRS), which is a 7-level ordinal scale from 0 - no disability, to 6- dead that is usually obtained by in-person or telephone interviews. The mRS can be prone to bias and can have significant inter-rater variability. Days alive and out of hospital at 90 days (DAOH-90) is an objective, readily available outcome measure that accounts for survival, time spent in hospital or rehabilitation settings, re-admission, and institutionalization. We aimed to assess the criterion, construct and face validity of DAOH. Methods: Consecutive ischemic stroke patients treated with thrombolysis or endovascular thrombectomy were used in this analysis. DAOH-90 was calculated from the national minimum dataset, an administrative nationwide database. mRS at 90 days was assessed with in-person or telephone interviews. Simple descriptive statistics were applied (median [IQR]). The ability of DAOH-90 to distinguish between the commonly applied cut-points of mRS-90 was assessed using the area under the receiver operating curve (AUROC). The associations of DAOH-90 with commonly used stroke prognostic variables were assessed with Spearman’s correlation. Results: 1067 ischemic stroke patients (481 male, median age 69 [58-78], median NIHSS 16 [11-20] were included in this study. Overall, median DAOH-90 was 68 [25-82] and median mRS-90 was 2 [1-4]. There was a strong association between mRS-90 and DAOH-90 (Spearman's rho correlation 0.79, p<0.001). AUROC (95% CI) for predicting mRS>0, mRS>1, mRS>2 were 0.85 (0.83-0.88), AUC 0.88 (0.86-0.90), AUC 0.90 (0.88-0.92) respectively. DAOH-90 was significantly correlated with age (spearman rho -0.37, p=0.002), admission NIHSS (spearman rho -0.37, p<0.001), Alberta stroke programme early CT score (spearman rho 0.23, p<0.001), and admission blood glucose concentration (spearman rho -0.24, p<0.001). Conclusion: DAOH is statistically valid outcome measure in ischemic stroke that strongly relates to mRS at 90 days. DAOH is an objective, patient-centric outcome measure that can be determined from large datasets and therefore its place in stroke research warrants further study.
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
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".