Association Between CT With Angiography and 30-Day Risk of Stroke or Transient Ischemic Attack in a Canadian Emergency Department Setting
Bibliographic record
Abstract
INTRODUCTION: A subset of undifferentiated vertigo cases can be attributed to dangerous central causes such as posterior circulation ischemic stroke (PCIS) or transient ischemic attack (TIA). Due to a lack of validated clinical risk scoring tools, there is currently high heterogeneity in emergency department (ED) neuroimaging practices for patients presenting with undifferentiated vertigo. Therefore, this study assessed the utility of head and neck CT with angiography (CTA) for risk stratifying ED patients presenting with vertigo. The primary objective of this study was to compare 30-day stroke and TIA outcomes between ED vertigo patients who received CTA at their index visit versus those who did not. The impact of index visit CTA on secondary outcomes of interest was also measured, including ED length of stay (LOS), hospital LOS, and 30-day ED revisit rate. METHODS: This retrospective study analyzed ED visit data across four tertiary care ED's over a one-year period. Adult patients presenting with a chief complaint of vertigo were eligible for study inclusion. Administrative data of the variables of interest was gathered from Canadian medical databases. Regression modeling was used to adjust for predetermined variables to evaluate the association between index visit CTA imaging, and stroke or TIA diagnosis at 30 days. RESULTS: A 30-day diagnosis for stroke or TIA was found in 20.7% of the CTA group, and in 1.2% of the No CTA group. The odds ratio (OR) was 22.3 (95% confidence interval (CI): 15.03-33.02) unadjusted, and 18.3 (95% CI: 14.85-22.45) after adjustment. The CTA group had a longer average ED LOS (+114 minutes), a shorter average total hospital LOS within 30 days (-2.2 days), and a higher 30-day ED revisit rate when compared to the No CTA group (4.0% versus 1.5%). CONCLUSIONS: Patients who received CTA at their index visit had 18.3 times greater odds of TIA or stroke diagnosis at 30-days, stayed longer in the ED, were more likely to revisit the ED within 30 days, and had a shorter mean hospital stay.
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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 | 0.000 | 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 | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".