Abstract TMP92: Circadian Variability in Pediatric Stroke
Bibliographic record
Abstract
Introduction: Ischemic stroke in adults demonstrates circadian variation in the timing of onset of symptoms, with the highest risk between 6am and noon (1-4). The influence of circadian timing on stroke biology may differ between children and adults, possibly related to the immature circadian system, variations in school versus work schedules, and diverse stroke pathophysiology (5). The goal of our study was to assess whether timing of ischemic stroke onset demonstrates circadian variability in children. Methods: We queried the International Pediatric Stroke Study, an international multicenter observational registry of children <18 years with arterial ischemic stroke (AIS). Included patients were aged 29 days-18 years with outpatient AIS and known time of stroke symptom onset. Clinical and radiographic features were compared according to 4 distinct time epochs: 6:00-11:59 (morning), 12:00-17:59 (afternoon), 18:00-23:59 (evening) and 00:00-5:59 (night). Clinical outcomes were defined by the Pediatric Stroke Outcome Measure (PSOM). Baseline, clinical and outcome characteristics were compared between the 4 time epochs using independent samples Kruskal-Wallis and Chi-square tests. Pairwise comparisons were conducted where needed. Results: A total of 478 patients met inclusion criteria, 54% male, mean age 9.9±SD 5.7 years. Time of stroke onset by hour is shown in Figure 1. Most strokes occurred in the afternoon (n=185, 38.7%), followed by morning (n=156, 32.6%). Table 1 shows demographic and clinical characteristics by time epoch; clinical and arteriopathy risk factors were more prevalent in nighttime strokes (23/36, 70%, p=0.034). Median PSOM scores at 6 months appeared to be better after evening strokes (0.5, IQR 0-1.5) as compared to morning strokes (1, IQR 0.5-2) and afternoon strokes (1, IQR 0.5-3, p=0.033), but failed adjustment for multiple comparisons (figure 2). Conclusion: Circadian influence on stroke timing appears to differ between adults and children. Further prospective studies with larger sample sizes are needed to understand the impact of circadian rhythm on stroke in childhood.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| 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".