Abstract WP139: Telestroke service for Endovascular Stroke Treatment in Canada: Results from the OPTIMISE Registry
Bibliographic record
Abstract
Background: Telestroke allows rapid assessment of patients presenting with acute stroke symptoms for intravenous thrombolysis or endovascular thrombectomy (EVT). Although the safety and efficacy of telestroke services for the delivery of intravenous thrombolysis has been well established, evidence on EVT decision-making is scarce. Methods: We analysed data from OPTIMISE, a quality improvement registry to support EVT implementation in Canada. We assessed for unadjusted differences in baseline characteristics, time metrics, and procedural outcomes between patients transferred for EVT who received telestroke consultation and those who didn’t receive the service. We used mixed-effects logistic regression models to compare the likelihood for symptomatic intracerebral hemorrhage (SICH), good functional outcome (defined as a modified Ranking Scale score of 0-2), or all-cause mortality at 90 days between the two groups. All models were adjusted for predefined confounders and participating centre. Results: Patients receiving telestroke consultation (n=997; 15%) had higher rates of carotid terminus occlusion (23.9% vs. 14.3%), but similar rates of M1-MCA and basilar occlusion compared to patients not receiving telestroke consultation (n=5,561). Patients receiving telestroke consultation had longer onset-to-door time (300.5 vs. 175 minutes) and onset-to-groin puncture time (344 vs. 233 minutes), but shorter door-to-groin puncture time (40 vs.70 minutes) compared to those not receiving telestroke consultation. No differences in groin puncture to reperfusion times, successful reperfusion rates, or adverse periprocedural events were found between the two groups. In the unadjusted analyses patients receiving telestroke consultation had higher rate of SICH (6.5% vs 3.1%), a lower rate for good functional outcome at 90-days (35.6% vs. 40.6%) and higher rate for all-cause mortality at 90 days (39.9% vs. 27.5%) compared to those not receiving telestroke consultation. Those differences were eliminated in the adjusted analyses. Conclusion: Patients receiving telestroke consultation prior to EVT have prolonged treatment times and worse outcomes, compared to patients that did not receive telestroke consultation prior to EVT. The higher risk for unfavorable outcomes was eliminated after adjustment for confounders, including treatment time. There is a need for quality improvement initiatives to optimize the workflow of patients receiving telestroke consultation prior to EVT.
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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 | 0.002 | 0.012 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.009 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".