{
  "abstract": "BackgroundPrediction models after stroke increasingly add neuroimaging information to bedside data. Whether findings documented in radiology reports improve short-term risk stratification beyond a patients evolving physiological state is unknown.\n\nMethodsWe studied 4,827 adults with acute ischaemic stroke, intracerebral haemorrhage or subarachnoid haemorrhage in MIMIC-IV (2008-2019). At eight landmarks from 6 to 48 hours after ICU admission, models ranked patients by their risk of deterioration or death within 24 hours. The baseline model combined demographic and clinical characteristics, a previously validated dynamic ICU state representation, and the physiology, treatment and imaging status at each landmark. A locally run language model extracted imaging phenotypes from 6,992 head CT and MRI reports; three phenotypes and four location categories met a pre-specified reliability criterion for automated extraction in independent validation and entered the model. The primary outcome was the difference in the proportion of events captured among the 10% of patients ranked highest at each landmark, in temporal validation (2017-2019; 8,923 patient-landmarks, 666 events).\n\nResultsAmong the highest-ranked 10%, adding imaging phenotypes captured no additional event (348 of 666 with and without them): a difference of 0.00 percentage points (95% CI -2.20 to +2.01). Discrimination (AUROC 0.855 vs 0.849), calibration and net benefit were similar. No prespecified sensitivity analysis, stroke subtype or availability-adjusted analysis showed statistically supported incremental capture. In a post hoc redundancy analysis, imaging phenotypes improved capture when added to demographic and clinical characteristics alone (+12.91 points, 7.54 to 17.81), but this gain was no longer evident once the dynamic state representation was included.\n\nConclusionsNeuroimaging phenotypes derived from routine radiology reports were associated with short-term deterioration, but we found no evidence that they added risk stratification value beyond the dynamic ICU state and contemporaneous physiology.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "name": "P. LEI"
    },
    {
      "name": "Y. XU"
    },
    {
      "name": "Y. ZHANG"
    },
    {
      "name": "N. RAY"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/d7wdfr96c94d4.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.08.26365059",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.08.26365059v1.full",
  "id": "d7wdfr96c94d4",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.08.26365059v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "health informatics"
    ],
    [
      "openalex",
      "2713|Acute Ischemic Stroke Management"
    ]
  ],
  "openalex": "W7221440627",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.08.26365059v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-08",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/d7wdfr96c94d4.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:38Z",
      "native_id": "10.64898/2026.10.08.26365059",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.08.26365059v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:health informatics",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Dynamic Risk Stratification for Short-Term Deterioration After Acute Stroke: Incremental Value of Radiology-Report-Derived Neuroimaging Phenotypes Beyond Dynamic ICU States, a retrospective cohort study with temporal validation",
  "title_text": "Dynamic Risk Stratification for Short-Term Deterioration After Acute Stroke: Incremental Value of Radiology-Report-Derived Neuroimaging Phenotypes Beyond Dynamic ICU States, a retrospective cohort study with temporal validation",
  "type": "preprint",
  "updated_at": "2026-10-30T12:20:38Z",
  "url": "https://research.draconitic.com/paper/d7wdfr96c94d4",
  "venue": "medRxiv",
  "versions": []
}