Abstract 82: The Association of Transfer Status and Time on Clinical and Imaging Outcomes in Large Core Strokes: <i>A SELECT2 Subanlaysis</i>
Bibliographic record
Abstract
Background: Patients with large core strokes have poor clinical outcomes and are frequently not transferred to endovascular thrombectomy (EVT)-capable centers for EVT. We analyzed the association of transfer status and time on neuroimaging changes, clinical outcomes and EVT treatment effect in SELECT2. Methods: Patients enrolled in the SELECT-2 trial were stratified based on transfer status. CT ASPECTS at outside hospital and EVT center were collected if available. Treatment effect was compared by transfer status as well as in transferred patients with outside ASPECTS ≤5. The association of ASPECTS loss during transfer was also quantified. The primary outcome was the distribution of modified Rankin Scale score at 90-day follow-up. Results: Of 352 enrolled patients, 211 (60%) were transferred to EVT capable center and 108(51%) received EVT. 141 presented directly and 72 (51%) received EVT. The median transfer time was 185 (140-234) minutes. Median ASPECTS decreased from outside hospital [5(4-7)] to EVT center [4 (3-5)] with ASPECTS decay rate at 0.31 (0-0.84) points/hour of transfer time, with 50/120 (42%) experienced ASPECTS loss ≥2. Thrombectomy treatment effect was preserved in both directly presenting patients [aGenOR: 2.01 (1.42-2.86)] as well as transferred patients [aGenOR: 1.50 (1.11-2.03)] without significant heterogeneity (P-int=0.14). EVT also demonstrated numerically better functional outcomes in transferred patients with outside ASPECTS of ≤5 (n=65, 35 EVT, aGenOR: 1.77 (0.97-3.23), p=0.068). ASPECTS loss was associated with worse clinical outcomes in EVT [aGenOR: 0.81 (0.71-0.83) per ASPECTS point loss] but not in MM: [aGenOR: 0.89 (0.73-1.08) per ASPECTS point loss]. Conclusion: In large core patients, transfer time was associated with ASPECTS decay, resulting in worse outcomes with EVT. Transferred patients however still benefited from EVT, with a trend towards better outcomes in patients with low ASPECTS at outside hospitals. These findings may substantially impact stroke care infrastructure, emphasizing the need for rapid identification of patients suitable for transfer and expedited transport. Clinicaltrials.gov registration: NCT03876457
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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 | 0.001 |
| 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 | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".