Pediatric acute stroke response protocols
Bibliographic record
Abstract
Background and purpose: The implementation of acute stroke response protocols has resulted in a decrease in the time to diagnosis of acute stroke in children at select institutions, and this is essential for expanding access to hyperacute therapies. We aim to describe existing pediatric acute stroke response protocols in the United States and Canada to better understand how pediatric centers might implement such protocols within the context of institution-specific structures. Methods: We performed a survey-based study of pediatric stroke specialists focused on institutional acute stroke protocols. The survey queried: hospital demographics; child neurology and pediatric stroke demographics; acute stroke response; imaging; and hyperacute treatment. Results: Forty-seven surveys were analyzed. Most respondents practice at large, free-standing children's hospitals with moderate-sized neurology departments and at least one neurologist with expertise in pediatric stroke. The majority of institutions have an acute stroke pathway or protocol, and all but one of these include the activation of a stroke alert page. Most institutions cite magnetic resonance imaging as the preferred imaging modality and employ abbreviated magnetic resonance imaging protocols for acute stroke imaging. Most institutions also have either computed tomography- or magnetic resonance-based perfusion imaging available. At least one patient had been treated with intravenous tissue plasminogen activator and/or mechanical thrombectomy at the majority of institutions in the year prior to our survey. Conclusions: An acute stroke response protocol is utilized in at least 41 pediatric centers in the United States and Canada. Most acute stroke response teams are multidisciplinary, have annual experience providing intravenous tissue plasminogen activator and/or mechanical thrombectomy, and prefer abbreviated magnetic resonance imaging over computed tomography for stroke diagnosis. Further studies are needed to standardize practices of pediatric acute stroke diagnosis and hyperacute management.
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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 | 0.017 | 0.044 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.004 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.024 | 0.009 |
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".