The First Eight Years of the Manitoba TeleStroke Program: An Observational Study
Bibliographic record
Abstract
BACKGROUND: Rural areas are often challenged in delivering time-sensitive hyper-acute stroke care. TeleStroke can improve access to time-sensitive reperfusion therapies. We aimed to evaluate our experience with TeleStroke and to explore if it facilitates reperfusion therapy in patients with acute ischemic stroke (AIS). METHODS AND ANALYSIS: The Manitoba TeleStroke Program was rolled out across seven sites between November 2014 and January 2019. We retrospectively included consecutive patients with suspected AIS within 4.5 hours of onset, between November 2014 to December 2022. Demographic data, process metrics, and outcome measures were collected. The primary outcome was safety and efficacy measured in terms of 90-day modified Rankin score (mRs). A descriptive and analytical analysis was performed. RESULTS: Of the 1,748 TeleStroke patients (median age 71 years, female 810 [46.3%]), 696 (39.8%) were identified as AIS. Of these, 265 (38.1%) received intravenous thrombolysis. Ninety-day mortality was 53 (20.0%) among those receiving thrombolysis and 117 (44.2%) had a favorable outcome of mRs≤2. Among patients receiving thrombolysis, nine (3.4%) had a symptomatic intracranial hemorrhage. Arrival by ambulance occurred in 1115 (63.8%) cases, median last-seen-normal-to-door time was 121 minutes, and median door-to-needle time was 55 minutes. When comparing "AIS-without thrombolysis" and "AIS with thrombolysis," the median last-seen-normal-to-door was 210 versus 90 minutes (p < 0.001); and the median door-to-CT scanner was 24 versus 22 minutes (p = 0.009). CONCLUSION: Intravenous thrombolysis for patients with AIS was found to be effective and safe in the Manitoba TeleStroke Program. Lessons learnt from our study will help improve the TeleStroke program in Manitoba and beyond.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 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".