Abstract WMP85: Site vs Core-lab CT ASPECTS read in the SELECT2 trial – assessment of trial eligibility and EVT treatment effect
Bibliographic record
Abstract
Introduction: Eligibility for clinical trial enrollment is often determined by site investigators with subsequent re-adjudication by an imaging core lab. We sought to assess the differences between site-investigator reported CT ASPECTS with core lab adjudication, and how these differences affected trial eligibility and endovascular thrombectomy (EVT) treatment effect. Methods: Absolute and relative differences between site and core-lab reported CT ASPECTS were recorded in the SELECT2 randomized trial. The agreement between measures was illustrated using Bland-Altman plots. Cases with extreme discordance were further examined for differences in baseline characteristics, as well as whether trial eligibility and EVT treatment effect were impacted. Results: Of 352 enrolled, 346 patients had both site and core-lab ASPECTS available for evaluation. Median (IQR) values for site ASPECTS, core lab ASPECTS and the difference between site and core-lab ASPECTS were 4 (3, 5), 4 (3, 5) and 0 (-1, 1). Mean (95% CI) difference between site and core-lab ASPECTS was -0.03 (-0.19, 0.13), with higher limit of agreement at 2.83 and lower limit of agreement at -2.9 – Fig 1. Significant disagreement of ≥3-point difference between site ASPECTS and core-lab ASPECTS was observed in 25 (7%) patients, with 14 having site ASPECTS ≥ 3 points higher and 11 having core-lab ASPECTS ≥ 3 points higher. EVT treatment effect was maintained based on site ASPECTS reads of 3-5 (aGenOR: 1.48, 95% CI: 1.16 to 1.89, p-value: 0.001) without significant heterogeneity as compared to other ASPECTS strata (p-interaction: 0.69) (Figure 2). In a sensitivity analysis excluding potential ineligible patients based on core lab reads [a) with core lab CT ASPECTS 0-2 and b) with core lab CT ASPECTS 6-10 and ischemic core estimates of <50ml], EVT treatment effect was maintained among patients with site read CT ASPECTS of 3-5 (aGenOR: 1.72, 95% CI: 1.26-2.34, p=0.001). Conclusions: Site investigator reads and core lab reads for ASPECTS score largely mirrored each other, with very low mean and median differences. Significant disagreement (≥3 points) between site and core-lab reads was limited and occurred in ~7% of cases. EVT benefit and treatment effect were maintained based on eligibility by investigators’ reads without heterogeneity in different ASPECTS strata.
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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 | 0.026 | 0.041 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.009 | 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".