Ambulatory vascular clinics provide a safe and effective pathway for management of chronic limb threatening ischaemia
Bibliographic record
Abstract
Introduction: The management of chronic limb threatening ischaemia (CLTI) has changed rapidly over recent years. The outcomes of lower limb revascularisation, despite improvements since centralisation, remain poor. Ambulatory emergency care has emerged in several surgical subspecialties as the optimal pathway to ensure timely access to specialist services whilst avoiding unnecessary urgent hospital admission and lengthy inpatient stays. This study aims to describe the outcomes of such a service for those with CLTI. Methods: This study includes all patients with suspected CLTI presenting to the Guy’s and St Thomas’ (GSTT) Emergency Vascular Clinic (EVC) between 31 July 2017 and 19 April 2021. Demographic, clinical and admission data were gathered from a prospectively maintained database. Operative details, in hospital and mid-term outcomes were gathered retrospectively from electronic hospital records. Frailty data were calculated using the Edmonton Frailty Scoring (EFS) System. Results: There were 799 encounters at the EVC for suspected CLTI. 375 (46.9%) of these encounters resulted in a confirmed diagnosis of CLTI and admission, either the same day as an emergency (187 (23.4%)) or as a planned urgent admission (188 (23.5%)). Time from referral to EVC review was a median of 1 day (interquartile range (IQR) 1–3 days) and median time from EVC review to revascularisation or amputation (in cases where this was the primary treatment strategy) was 8 days (IQR 4–16 days). Median time to admission was 1 day (IQR 0–13 days and length of stay was a median of 7 days (IQR 2–15 days). Amputation-free survival (AFS) from the first patient encounter (with presentations for each leg taken separately) was 95% at one month and 78% at one year. Overall survival was 98% at one month and 84% at one year. Frailty was significantly associated with mortality (p=0.03), but not AFS (p=0.085). Conclusion: These data suggest that an EVC pathway provides a safe method of treating CLTI with minimal delays to urgent planned admission, revascularisation and AFS, in keeping with nationally reported data.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".