bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 29: Non-gated Dual-source Photon-counting CT Angiography Can Detect Cardioembolic Sources Of Acute Ischemic Stroke At The Primary Investigation: A Retrospective Consecutive Cohort Study
Authors: Stahl Fredrik , Szum Adrian , Damlin Anna , Planken R. Nils , Coutinho Jonathan , Granberg Tobias , Lundberg Johan 
Published: January 2025

Introduction:
Early identification of the etiology of ischemic stroke is crucial for secondary prevention. Recent publications on dedicated ECG-gated cardiac CT showcase the potential to detect sources of cardiac embolism.

Photon-counting CT (PCCT) uses semiconductors to convert X-ray photons into electrical signals directly. This allows for improved image quality and lower radiation dose compared to conventional CT. Exploiting PCCT technology with a high-pitch dual-source image acquisition may render an exceptionally high temporal resolution.
We hypothesized that non-ECG-gated high-pitch dual-source PCCT angiography from the diaphragm to the brain might provide added clinical value in detecting cardiac stroke sources during initial stroke imaging while maintaining optimal brain and neck image quality.

Methods:
Consecutive patients with a clinical suspicion of acute stroke imaged with a PCCT system between October 4
th
, 2023 and April 13
th
, 2024 at a Swedish comprehensive stroke center were included. Diaphragm to brain coverage was obtained in an acquisition time of 1.3 seconds; on average, yielding a dose-length product of 360 mGy*cm for the study participants (2.34 mSv). Image quality was graded using a 4-point Likert scale. Images were assessed for cardiac stroke sources. Where available, reference standard echocardiography results were collected.

Results:
Of 249 consecutive stroke investigations, 193 included cardiothoracic imaging, which constituted the study population. 126 scans (65.3%) were cases with imaging confirmed ischemic stroke. The median age was 74 (IQR, 61-81) years, 99 were male (51.3%). In total, 39.4% underwent follow-up echocardiography.

Image quality of the heart was excellent in 19 scans (9.8%) good in 97 (50.3%), moderate in 72 (37.3%), and poor in 5 scans (2.6%). Fourteen (7.3%) certain or probable interatrial septal defects were found in the study population. In the imaging-confirmed ischemic stroke subgroup, six certain or probable cardiac thrombi were found (4.8%). Additionally, a possible cardiac thrombus was found in 31 instances (24.6%). Three aortic valve vegetations were found (2.4%), all confirmed by echocardiography.

Conclusions:
Non-ECG-gated high-pitch dual-source PCCT angiography typically provides images of high quality, at virtually no time expense while maintaining a reasonably low radiation exposure. Non-gated PCCT angiography is a promising technique to be used as a primary screening method for cardioembolic stroke.
Abstract TMP27: Impact of the COVID-19 Pandemic on In-Hospital Stroke Mortality in California: A Retrospective Analysis from 2016 to 2022
Authors: Shanaa Jean , Augustynski Robert , Chang Sean , DILIBERO RALPH , Ratnasiri Anura 
Published: January 2025

Background:
In 2022, stroke shifted from the fourth to the fifth leading cause of death in the U.S. as COVID-19 temporarily took its place. Despite this change, stroke remains a significant cause of mortality and long-term disability in the U.S. This study analyzes trends in in-hospital mortality among stroke-related hospitalizations in California from 2016 to 2022, with a particular focus on the pandemic years.

Methods:
This retrospective analysis utilized patient discharge data from the California Department of Health Care Access and Information, screening nearly 25 million inpatient events for stroke-related ICD-10-CM diagnosis codes (I60-I63) among individuals 20 and older. Multivariate logistic regression (MLR) analysis assessed the impact of the pre- and post-COVID-19 periods on in-hospital mortality, adjusting for confounders such as age, gender, race and ethnicity, geographic regions, and payer source. Results were interpreted using Adjusted Odds Ratios (AOR).

Results:
The study identified 590,801 stroke-related hospitalizations and 66,096 in-hospital deaths (11.2%). Initially, the age-and-sex-adjusted in-hospital mortality rate decreased from 28.88 per 100,000 in 2016 to 27.38 in 2019. However, with the onset of COVID-19 in 2020, the rate increased to 27.94, peaking in 2021 at 30.78 during the pandemic's height. In 2022, the rate slightly declined to 28.30 but remained above pre-pandemic levels.

Similar trends from 2016 to 2022 were observed in age-adjusted rates for males, which increased from 27.77 to 29.73, and for females, which decreased from 29.91 to 26.98. The gap between male and female mortality rates widened significantly during the pandemic, with male mortality peaking in 2021 with a difference of 3.75.
MLR analysis revealed a 22.6% increase in in-hospital mortality during the post-COVID period compared to the pre-COVID period (AOR=1.23, p<0.001). Additionally, male mortality was 25.3% higher than female mortality (AOR=1.25, p<0.001). Racial disparities were also noted, with Asians having a 53.9% higher prevalence of stroke compared to Whites (AOR=1.54, p<0.001), followed by Blacks at 38.8%.

Conclusion:
The COVID-19 pandemic significantly impacted in-hospital stroke mortality rates in California, particularly during the peak in 2021. The study highlights the differential impact on males, who experienced higher mortality increases, and the pronounced racial disparities, with Asians and Blacks showing higher prevalence rates compared to Whites.
Abstract TMP31: Distinguishing Intracerebral Hemorrhage from Acute Cerebral Ischemia in the Prehospital Setting: Development and Validation of the California Acute stroke Subtype PRehospital (CASPR) Scale
Authors: Hsu Jamie , Eckstein Marc , Stratton Samuel , Liebeskind David , Sharma Latisha , Restrepo Lucas , Kim-Tenser May , valdes-sueiras miguel , Gornbein Jeffrey , Hamilton Scott , Conwit Robin , Taleb Shayandokht , Sung Gene , Saver Jeffrey , Sanossian Nerses 
Published: January 2025

Background:
A prehospital, paramedic-administered scale to distinguish intracerebral hemorrhage (ICH) from acute cerebral ischemia (ACI) could improve routing to appropriate centers, enrich field randomized trials with targeted subtype patients, and potentially guide prehospital clinical treatment such as hyperacute blood pressure (BP) lowering. We aimed to create a quickly administered prehospital scale from prospectively performed field assessments.

Methods:
Two scales were created from NIH Field Administration of Stroke Therapy Magnesium (FAST-MAG) trial data, using logistic regression model with backward stepwise variable selection and retention criterion of p<0.1. Scale one—CASPR-DB (Data-Based)—assessed 26 candidate variables available in routine prehospital care in 1675 patients (77.3% ACI, 22.7% ICH), who were randomly assigned to training (n=1114) or validation (n=561) sets. Scale two—CASPR-CS (Clinical Symptoms)—came from a subset of patients (n=467) in whom three additional clinical symptoms elicited in the field were also candidate items—headache, nausea, and progressing deficit.

Results:
For the CASPR-DB scale, the logistic regression model selected 10 of the 26 candidate variables in the training population. Factors associated with ICH were higher Los Angeles Motor Scale (LAMS) score, higher Glasgow Coma Score (GCS), higher systolic BP, Hispanic and Caucasian race-ethnicity, male sex, use of anti-platelet agents, decreased age, and absence of diabetes, atrial fibrillation, or valvular heart disease. Each was given a point value between 1-3, yielding a 19-point scale (Table 1).

For the CASPR-CS scale, the logistic regression model selected 10 of the 29 candidate variables. All three symptom items—headache, nausea, and progressing deficit—were associated with ICH, along with 7 data-based variables. Each was given a point value between 1-3, yielding a 20-point scale (Table 2).
CASPR-DB performance in training was sensitivity 64.4%, specificity 78.6%, accuracy 71.5%, c=0.774 and in validation was sensitivity 69.3%, specificity 61.7%, accuracy 71.5%, c=0.710. CASPR-CS performance was sensitivity 71.8%, specificity 77.8%, accuracy 74.8%, c=0.830. Figure 1 shows the proportions of ICH patients at each CASPR-CS score level.

Conclusions:
The CASPR-DB scale shows good and CASPR-CS scale very good performance in distinguishing ICH vs ACI in prehospital setting. These readily performable scales could improve prehospital routing and treatment of ICH patients.
Abstract TMP36: The Ultimate Stroke Scale (USS): An Innovative Tool for Automated LVO Screening and Stroke Scale Accuracy
Authors: Kothari Sachin , Morsi Rami , Desai Harsh , Carrion Penagos Julian , Baskaran Archit , Kozel Olivia , Sehgal Neha , Metman Okker , Chahine Ahmad , Patel Shyam , Karar Lina , Iourinets Julia , Rana Rohini , Thind Sonam , Coleman Elisheva , Brorson James , Siegler James , Prabhakaran Shyam , Kass-Hout Tareq 
Published: January 2025

This study compares the accuracy of manual stroke scale calculations against electronically calculated scores using the Ultimate Stroke Scale (USS), a new software designed to automate large vessel occlusion (LVO) screening scales from a modified National Institute of Health Stroke Scale (NIHSS). The USS has the potential to streamline LVO screening with enhanced accuracy using multiple validated stroke scales simultaneously.
We prospectively applied eight stroke screening scales (NIHSS, BE-FAST, VAN, LAMS, FAST-ED, EMS RACE, 3-ISS, and PASS) to 199 stroke activations between January 2021 to December 2023. These values were recalculated with the USS calculator which incorporates inputs from a modified NIHSS score, including up to two additional points for hand grip strength. A Bland-Altman analysis was conducted to assess agreement between manual and USS-calculated scores.
The NIHSS showed a percentage error of -8.24% and a mean difference of -0.97 (LoA: -3.88 to 1.93). The BE-FAST scale exhibited a percentage error of -14.72% and a mean difference of -0.12 (LoA: -0.85 to 0.60). The VAN scale had a percentage error of -21.76% and a mean difference of -0.11 (LoA: -0.83 to 0.62). The LAMS scale had a percentage error of 6.59% and a mean difference of 0.15 (LoA: -1.20 to 1.50). The FAST-ED scale had a percentage error of -4.82% and a mean difference of -0.15 (LoA: -2.10 to 1.80). The EMS-RACE scale had a percentage error of -9.99% and a mean difference of -0.39 (LoA: -3.20 to 2.42). The 3-ISS scale exhibited the highest percentage error of -29.36% and a mean difference of -0.54 (LoA: -2.47 to 1.39). The PASS scale had the lowest percentage error at -2.86% and a mean difference of -0.04 (LoA: -0.66 to 0.58). The combined percentage error for all scales was -8.44%, increasing slightly to -8.61% when excluding the NIHSS score. Excluding both NIHSS and 3-ISS reduced the combined error to -5.44%.
Our findings demonstrate a general agreement between the manual and USS-calculated scores, with the strongest concordance observed in PASS, FAST-ED, and LAMS. Although some scales exhibited larger discrepancies, the moderate overall combined percentage error suggests that USS-calculated scores are generally consistent with manual calculations. These findings support the potential of the USS software to streamline LVO stroke screening, although further validation is necessary.
Abstract TP102: Exploring the Role of Podcasts in Stroke Recovery and Prevention
Authors: Hart Rosa 
Published: January 2025

The recovery process for stroke patients requires ongoing reinforcement of critical health information. Traditional education methods of written handouts often fail to adequately meet patient needs, particularly for those with limited literacy, or busy lifestyles. Podcasts are emerging as a powerful tool in patient education, offering a flexible, accessible, and engaging format that can be accessed anytime, anywhere.
The hypothesis was that by prescribing podcasts, we could ensure patients have continuous access to vital information, allowing for repeated exposure and improved retention of key concepts. Studies have shown that podcasts can significantly enhance knowledge retention and listener engagement, even when listeners are engaged in other activities, as verified by EEG. This makes podcasts a practical solution for reinforcing key health messages and catering to diverse learning preferences, offering an alternative for patients who may struggle with written materials. Since neurological patients struggle to retain complex medical information provided during brief consultations, this can lead to gaps in understanding, and consequently suboptimal outcomes.
Putting this hypothesis to the test, our method was to create a podcast with episode topics selected by a multidisciplinary stroke team, focusing on the frequently asked questions posed by stroke survivors and caregivers. Each podcast episode features interviews with expert guests or stroke survivors who discuss strategies and resources relevant to the topic. To enhance accessibility, links to printable information and specialist directories are provided in the show notes of each episode.
The results demonstrate global demand for access to such specialized information, with regular listeners in 56 countries, all 50 of the United States and over 1600 downloads in outlying US territories. Each new episode consistently averages 300 audio downloads or video views in the first week they are released.
In conclusion, neurology providers are encouraged to incorporate podcasts as a standard component of their stroke patient education strategy. Also, future research should focus on developing specialized neurological podcasts tailored to community needs, providing insight into how to aid them to better understand and manage their conditions, ultimately contributing to improved adherence to treatment plans and better quality of life.
Abstract TP143: Improving CT imaging in Non-Fatal strangulation Domestic Violence Victims
Authors: Donegal Kereisha , Hiana James , Law Susan , Kang Derrek , Soh James 
Published: January 2025

Introduction:
The incidence of domestic violence (DV) can vary from 2 to 4 million in a year. Domestic violence can be broad in definition and not limited to physical assault. The role of the medical provider in caring for these patients can be difficult; studies suggest that less than 10% of these cases are diagnosed correctly in the emergency room.

In collaboration with Brooklyn District Attorney office, we examined and designed a quality improvement study to look at the performance of CT imaging in non-fatal strangulation DV in the emergency department from 8/1/2021 to 3/31/2024 of all NYC Health and Hospitals System (NYCHH). The timely identification of arterial dissection can potentially lead to a decrease risk of stroke.

Methods:
We developed a non-fatal strangulation pathway in the emergency department for DV patients. We examined the use of CT head and CTA head and neck. The utilization of CT was monitored every quartile. Cases were abstracted with diagnoses of DV and asphyxiation. Strategies were employed to encourage and improve the utilization of pathway.

Results:
In total, 2163 domestic violence cases were abstracted from electronic medical records.

63% (n=1363) female
5.2% (113) male
31.7% (n=687) did not select for sex (NOA)
The percentage of CT performance during 8/1/2021 through 3/31/2024 was 5.5% (116/2163). Upon further evaluation, the percentage of female cases imaged was 5.5% (75/116); by contrast, male cases were imaged at 24.8% (28/116), and NOA 1.9% (13/116).
The odds ratio of CT performances in noted cases was 4.5 [95% CI 2.8016-7.2381], 13.0946 [6.5861-26.0349], 2.9 [1.6024-5.277], Male to female cases, male to NOA, and Female to NOA, respectively.

Discussion:
The literature on domestic violence range in incidence from 2 million to 4 million in a year. The identification of stroke risk factors from a domestic violence incident is a novel approach and has not been fully elucidated.

Non-fatal strangulation is known to decrease cerebral perfusion; the risk of developing an arterial dissection is known. Arterial dissection is an independent risk factor for ischemic stroke. In this study, we have observed a low utilization of imaging to rule out dissection; there is a suggestion of disparity among the sexes in diagnosis.

Conclusion:
The observation from this study involving all hospitals in the NYCHH system reveals a need to better educate and improve diagnosis of domestic violence. This can lead to prompt intervention and medical stabilization.
Abstract TP201: Factors associated with development of venous thromboembolism in patients with intracranial hemorrhage.
Authors: Hataway Felicia , Wang Lingling , Morgan Charity , May Jori , Lin Chen 
Published: January 2025

Background:
Patients with intracerebral hemorrhage (ICH) are known to have a higher risk of venous thromboembolism (VTE) than patients with acute ischemic stroke, but the factors underlying this difference have not been clearly identified. We investigated common characteristics of patients admitted for ICH to both determine the frequency of VTE in the population and to identify risk factors for the development of VTE.

Methods:
This study was a single center, retrospective review of consecutively admitted patients with ICH between January 2014 to May 2019 at an academic tertiary referral hospital. We calculated odds ratios (OR) and 95% confidence intervals (95%CI) for development of VTE based off demographics and clinical characteristics. Risk factors with significant OR were then analyzed by multivariate logistic regression.

Results:
The final cohort included 465 patients with ICH, with 58 developing in-hospital thromboembolic events (12.5%). Time to start of chemoprophylaxis overall was 5.12 days (±4.56), for patients who developed VTE the time to chemoprophylaxis was 10.09 days (±7.55), and for those without VTE 4.18 days (±2.93). Delayed initiation of chemoprophylaxis reached statistical significance (p<0.0001) in patients who ultimately developed VTE.

There were several factors that were significantly associated with presence of VTE: black race OR 2.87 (95% CI: 1.530-5.939, p=0.0027), presence of intraventricular hemorrhage OR 2.20 (95% CI: 1.240-3.91, p=0.0071), placement of extraventricular drain OR 6.12 (95% CI: 3.2-11.73, p=<0.0001), craniotomy OR 4.635 (95% CI: 1.952-11.007, p=0.0005), and ICH score ≥2 OR 4.346 (95% CI: 1.784-10.587, p=0.002).
Factors which were not clearly associated with presence of VTE included gender, age, ICH location (deep or lobar), recurrent ICH, ICH etiology, procedures other than extraventricular drain and craniotomy, and whether patients were on anticoagulation or antiplatelet agents prior admission.

Conclusions:
Increased incidence of thrombosis was clearly associated with several factors including race, presence of intraventricular hemorrhage, ICH score of 2 or 3, intervention with EVD or craniotomy, and delay to initiation of chemoprophylaxis.
Abstract WMP115: Towards a Comprehensive Computational Model of Ischemic Stroke: Integrating Detailed Microvasculature With Advanced Model of Brain Tissue Metabolism
Authors: Dehkharghani Seena , Brantner Douglas , Ventimiglia Thomas , Collins Christopher , Linninger Andreas 
Published: January 2025

Intro:
Resources for studying stroke are limited to clinical trials with sparse access to physiological and biochemical details, and pre-clinical animal studies with limited relation to humans. A physiologically accurate in silico model would provide a new route for study of the response to an ischemic event. Here we combine a computational model of brain tissue metabolism modified to simulate effects of ischemia (1) with an experimentally-validated approach to model the distribution of nutrients to the extravascular space as provided by a specific cerebral microvasculature network (2,3) to produce simulations of ischemic stroke showing the spatial distribution of damaged and healthy tissue.

Methods:
Anatomically-accurate models of cortical microvasculature and resulting O2 concentration with consideration of oxygen consumption in tissue were developed and validated against experimental measures of pO2 (2,3, Figure 1). A numerical implementation of a 4-compartment cellular model of brain metabolism (4) was modified to simulate ischemic stroke (1), and further modified to consider effects of the local pO2 and Glucose (GLC) as provided by the vascular network by adjusting local rates of transfer of GLC and O2 into the neuronal compartment of the cell, as shown in Figure 2, bottom. Brain metabolism was simulated for cases with no ischemic event, and after CBF was reduced by 80%.

Results:
Figure 2 shows timecourse of GLC, ATP, and Sodium in different compartments of the model through time in regions experiencing mild and severe ischemia. Figure 3 shows intraneuronal sodium concentration before and 2 hours after onset of an ischemic event showing failure of sodium pumps during ischemia.

Conclusion:
Effects of ischemic stroke on cerebral metabolism at the cellular level with consideration of microvasculature and distribution of nutrients within the tissue can be modelled at the capillary and cellular level computationally. Future work will include linking astrocytes to local nutrient concentrations and expansion of the simulated region to include larger region of brain, so an ischemic core and penumbral region surrounded by unaffected tissue can be observed.

References
1. CM Collins et al. International Stroke Conference, February 7-9 2024, Phoenix
2. T Ventimiglia et al. Int J Numer Meth Biomed Engng. 2023;39:e3735
3. G Hartung et al. PLOS Computational Biology 2020;17(1): e1008584
4. M Cloutier et al. Journal of computational neuroscience. 2009 Dec 1;27(3):391