Bibliographic record
Abstract
In patients with suspected acute stroke, prompt neuroimaging is required to determine eligibility for revascularization treatment, and earlier revascularization increases its benefit for patients of any age and any type of stroke severity; yet little is known about the frequency, predictors, and outcomes of timely neuroimaging. The objectives of this thesis were to (1) describe the characteristics of patients with suspected acute ischemic who do and do not receive timely neuroimaging; (2) assess the potential benefits of screening for suspected acute ischemic stroke with computed tomography perfusion (CTP) neuroimaging, within a meta-analysis of experimental and observational studies; and (3) assess outcomes of patients with suspected acute ischemic stroke who do and do not receive timely neuroimaging. In the retrospective cohort study of the time to neuroimaging in Ontario patients with suspected acute ischemic stroke, we found that 27.3% of patients with stroke-like symptoms who presented within the four-hour intravenous (IV) thrombolytic treatment window received timely neuroimaging. Neuroimaging delays were significantly influenced by several patient and hospital factors including a less severe stroke, longer time from symptom onset to presentation, female sex, and presentation to a rural hospital. The meta-analysis of outcomes among patients with acute ischemic stroke who were screened using perfusion computed tomography (CTP) imaging demonstrated that mortality, morbidity and symptomatic intracranial hemorrhage (SICH) rates appear favourable for patients selected with CTP imaging to receive IV thrombolytic treatment more than three hours after symptom onset. Finally, in our second retrospective cohort study we found that timely neuroimaging was associated with higher use of intravenous thrombolysis, no difference in the risk of hemorrhage or mortality, and a greater likelihood of disability at discharge. Overall, these results reaffirm the importance of multi-level efforts to optimize timely neuroimaging among patients who present with suspected acute stroke. Specific contributions of this work to the understanding of management, clinical decision-making and directions for future research in acute stroke neuroimaging and care are discussed.
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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 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".