Abstract 132: The Canadian TIA Rule - A Decision Rule to Predict the Risk Of Stroke Within Seven Days In The Emergency Department
Bibliographic record
Abstract
Background: Stroke prevention after TIA is dependent on rapid intervention in those at highest risk. Previous risk scores have not been prospectively developed and thus do not consider all relevant variables. The goal of this study was to derive a clinical score for TIA patients to identify those at high risk for stroke ≤ 7 days. Methods: We conducted a prospective cohort study in 8 academic Canadian EDs. We enrolled consecutive adult ED patients diagnosed with a TIA. Standardized clinical variables were recorded by physicians on data forms prior to discharge/admission. Our primary outcome was stroke ≤ 7 days of TIA diagnosis. We derived a clinical score using logistic regression analysis. Results: We prospectively enrolled 3,903 patients including 85 patients with a subsequent stroke ≤ 7 days. From this cohort we derived the Canadian TIA Score . The Canadian TIA Score identifies patients at minimal risk of subsequent stroke ≤ 7 days (probability < 0.5%), low risk (0.5-2.5%), high risk (2.6-10.0%), and critical risk (>10.0%). This score contains 13 variables; 9 clincal: 1) initial TIA (in lifetime) 2) symptoms lasting ≥10 minutes, 3) already on an antiplatelet agent, 4) history of carotid stensosis, 5) history of gait disturbance, 6) unilateral weakness, 7) vertigo, 8) initial diastolic blood pressure ≥110 mmHg, 9) history or exam finding of dysarthria or aphasia; and four from investigations: 1) atrial fibrillation on electrocardiogram, 2) infarction on CT head, 3) platelets ≥400 x 10 9 /L, 4) glucose ≥15 mmol/L. Variables were assigned point values ranging from 4 to -3, and added, obtaining a score from -3 to 19. This model has good discrimination with a c-statistic of 0.77 (95%CI: 0.73-0.82). Importance: The Canadian TIA Score identifies the subsequent stroke risk at 7 days following a TIA. Following validation, the Canadian TIA Score will allow physicians to selectively expedite investigations/specialist assessment and allow for safe less urgent follow-up of patients at low risk. Appropriate intervention is contingent on appropriate risk assessment.
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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 | 0.004 | 0.031 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
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".