E-238 Factors influencing the association between 24-hour national institutes of health stroke scale and 90-day modified ranking score in patients undergoing thrombectomy for large vessel occlusion stroke
Bibliographic record
Abstract
Background The modified Rankin Scale (mRS) at 90 days is the primary outcome in most acute stroke studies, but the long follow-up period has disadvantages, including increased trial costs and the risk of patients being lost to follow-up. The National Institutes of Health Stroke Scale (NIHSS) at 24 hours shows a strong, but imperfect, association with 90-day mRS. This study examines the association between 24-hour NIHSS and 90-day mRS and explores reasons for disagreement. Methods Secondary analysis of the ESCAPE-NA1 trial in which large vessel occlusion stroke patients undergoing thrombectomy were randomized to Nerinetide or placebo. A 7-point ordinal score was generated by grouping 24-hour NIHSS including death as a separate category (‘ordinal’ NIHSS). Ordinal unadjusted and adjusted logistic regression was performed to examine the association of ordinal 24-hour NIHSS and 90-day mRS. Differences in baseline, treatment and post-treatment variables were compared between patients with discordant (e.g., low 24-hour NIHSS but high 90-day mRS and vice versa) and concordant outcomes. Results One-thousand-seventy-six patients with available 24-hour NIHSS and 90-day mRS were included (median 24-hour NIHSS 6[IQR: 2–14], median 90-day mRS 2[IQR: 1–4]). Ordinal 24-hour NIHSS was strongly associated with 90-day mRS (adjusted OR 2.53 [95%CI 2.33–2.74]). Forty-eight (4.5%) patients had discordant outcomes. Of those, 19 (1.8%) had a 24-hour NIHSS <6 and 90-day mRS 5–6; all of which had at least one severe adverse event, most commonly pneumonia (6[31.6%]) or recurrent stroke (4[21.1%]). Twenty-nine patients (2.7%) had a 24-hour NIHSS>14 and 90d-day mRS 0–2. In these patients, baseline NIHSS and ASPECTS was lower, also the collateral status was worse compared to the remaining patients. Conclusion An ordinal NIHSS score that includes death at 24hours as a separate category shows a strong association with 90-day mRS, suggesting that it could be used as an alternative primary outcome. Patients with discrepant outcomes differed from the remaining patients regarding their baseline NIHSS, ASPECTS, collateral status and post-stroke complications. Disclosures A. Stebner: 1; C; Swiss Society of Radiology. S. Bosshart: None. A. Demchuk: None. A. Poppe: None. R. Nogueira: None. R. McTaggert: None. B. Buck: None. A. Ganesh: None. M. Hill: 1; C; Medtronic. M. Goyal: 1; C; Medtronic. J. Ospel: None.
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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 | 0.001 |
| 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 | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.007 | 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".