{"id":"https://openalex.org/W7212009727","doi":"https://doi.org/10.64898/2026.09.07.26362407","title":"External validation of dynamic clinical states in acute stroke: transportability and independent rediscovery across 176 hospitals","display_name":"External validation of dynamic clinical states in acute stroke: transportability and independent rediscovery across 176 hospitals","publication_year":2026,"publication_date":"2026-09-08","ids":{"openalex":"https://openalex.org/W7212009727","doi":"https://doi.org/10.64898/2026.09.07.26362407"},"language":"en","primary_location":{"id":"doi:10.64898/2026.09.07.26362407","doi":"https://doi.org/10.64898/2026.09.07.26362407","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.07.26362407","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/08/2026.09.07.26362407.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/08/2026.09.07.26362407.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5148921166","display_name":"Ping LEI","orcid":"https://orcid.org/0000-0002-8904-3167","observed_orcids":["https://orcid.org/0000-0002-8904-3167"]},"institutions":[{"id":"https://openalex.org/I114457229","display_name":"University of Geneva","ror":"https://ror.org/01swzsf04","country_code":"CH","type":"education","lineage":["https://openalex.org/I114457229"]},{"id":"https://openalex.org/I24943067","display_name":"Fudan University","ror":"https://ror.org/013q1eq08","country_code":"CN","type":"education","lineage":["https://openalex.org/I24943067"]}],"countries":["CH","CN"],"is_corresponding":true,"raw_author_name":"Ping Lei","raw_affiliation_strings":["Institute of Global Health, University of Geneva, Geneva, Switzerland","Overseas Liaison Department, School of Public Health, Fudan University, Shanghai 200032, China"],"raw_orcid":"https://orcid.org/0000-0002-8904-3167","affiliations":[{"raw_affiliation_string":"Institute of Global Health, University of Geneva, Geneva, Switzerland","institution_ids":["https://openalex.org/I114457229"]},{"raw_affiliation_string":"Overseas Liaison Department, School of Public Health, Fudan University, Shanghai 200032, China","institution_ids":["https://openalex.org/I24943067"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5059006900","display_name":"Yanyi Xu","orcid":"https://orcid.org/0000-0003-0270-2017","observed_orcids":["https://orcid.org/0000-0003-0270-2017"]},"institutions":[{"id":"https://openalex.org/I24943067","display_name":"Fudan University","ror":"https://ror.org/013q1eq08","country_code":"CN","type":"education","lineage":["https://openalex.org/I24943067"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Yanyi Xu","raw_affiliation_strings":["Department of Environmental Health, School of Public Health, Fudan University, Shanghai 200032, China"],"raw_orcid":"https://orcid.org/0000-0003-0270-2017","affiliations":[{"raw_affiliation_string":"Department of Environmental Health, School of Public Health, Fudan University, Shanghai 200032, China","institution_ids":["https://openalex.org/I24943067"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5006240342","display_name":"Yuxia Zhang","orcid":"https://orcid.org/0000-0003-4419-7004","observed_orcids":["https://orcid.org/0000-0003-4419-7004"]},"institutions":[{"id":"https://openalex.org/I24943067","display_name":"Fudan University","ror":"https://ror.org/013q1eq08","country_code":"CN","type":"education","lineage":["https://openalex.org/I24943067"]},{"id":"https://openalex.org/I4210127074","display_name":"Zhongshan Hospital","ror":"https://ror.org/032x22645","country_code":"CN","type":"healthcare","lineage":["https://openalex.org/I4210127074"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Yuxia Zhang","raw_affiliation_strings":["Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China"],"raw_orcid":"https://orcid.org/0000-0003-4419-7004","affiliations":[{"raw_affiliation_string":"Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China","institution_ids":["https://openalex.org/I24943067","https://openalex.org/I4210127074"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":3,"corresponding_author_ids":["https://openalex.org/A5148921166"],"corresponding_institution_ids":["https://openalex.org/I114457229","https://openalex.org/I24943067"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":1,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T13702","display_name":"Machine Learning in Healthcare","score":0.9653000235557556,"subfield":{"id":"https://openalex.org/subfields/1702","display_name":"Artificial Intelligence"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},"topics":[{"id":"https://openalex.org/T13702","display_name":"Machine Learning in Healthcare","score":0.9653000235557556,"subfield":{"id":"https://openalex.org/subfields/1702","display_name":"Artificial Intelligence"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T10227","display_name":"Acute Ischemic Stroke Management","score":0.017500000074505806,"subfield":{"id":"https://openalex.org/subfields/2728","display_name":"Clinical Neurology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11396","display_name":"Artificial Intelligence in Healthcare","score":0.005900000222027302,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/acute-stroke","display_name":"acute stroke","score":0.9520000219345093},{"id":"https://openalex.org/keywords/external-validation","display_name":"external validation","score":0.7279999852180481},{"id":"https://openalex.org/keywords/transportability","display_name":"transportability","score":0.9139999747276306},{"id":"https://openalex.org/keywords/eicu-collaborative-research-database","display_name":"eICU-CRD","score":0.6060000061988831},{"id":"https://openalex.org/keywords/organ-support","display_name":"organ support","score":0.7239999771118164},{"id":"https://openalex.org/keywords/invasive-mechanical-ventilation","display_name":"invasive mechanical ventilation","score":0.75},{"id":"https://openalex.org/keywords/icu-mortality","display_name":"ICU mortality","score":0.949999988079071},{"id":"https://openalex.org/keywords/neurological-deficit","display_name":"neurological deficit","score":0.6959999799728394},{"id":"https://openalex.org/keywords/clinical-phenotyping","display_name":"clinical phenotyping","score":0.41600000858306885},{"id":"https://openalex.org/keywords/multicentre-cohort","display_name":"multicentre cohort","score":0.3490000069141388}],"concepts":[{"id":"https://openalex.org/C2987404301","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care","level":2,"score":0.5622000098228455},{"id":"https://openalex.org/C2776359362","wikidata":"https://www.wikidata.org/wiki/Q2145286","display_name":"Representation (politics)","level":3,"score":0.5238999724388123},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.483599990606308},{"id":"https://openalex.org/C164226766","wikidata":"https://www.wikidata.org/wiki/Q7293202","display_name":"Rank (graph theory)","level":2,"score":0.4510999917984009},{"id":"https://openalex.org/C104709138","wikidata":"https://www.wikidata.org/wiki/Q1671540","display_name":"Intraclass correlation","level":3,"score":0.43880000710487366},{"id":"https://openalex.org/C2780645631","wikidata":"https://www.wikidata.org/wiki/Q671554","display_name":"Stroke (engine)","level":2,"score":0.40400001406669617},{"id":"https://openalex.org/C2777080012","wikidata":"https://www.wikidata.org/wiki/Q3766250","display_name":"Mechanical ventilation","level":2,"score":0.3808000087738037},{"id":"https://openalex.org/C105795698","wikidata":"https://www.wikidata.org/wiki/Q12483","display_name":"Statistics","level":1,"score":0.357699990272522},{"id":"https://openalex.org/C48103436","wikidata":"https://www.wikidata.org/wiki/Q599031","display_name":"State (computer science)","level":2,"score":0.3208000063896179},{"id":"https://openalex.org/C2992870097","wikidata":"https://www.wikidata.org/wiki/Q3259564","display_name":"Patient discharge","level":3,"score":0.3077000081539154},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.3043999969959259},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.28859999775886536},{"id":"https://openalex.org/C187212893","wikidata":"https://www.wikidata.org/wiki/Q123028","display_name":"Pediatrics","level":1,"score":0.27649998664855957},{"id":"https://openalex.org/C18762648","wikidata":"https://www.wikidata.org/wiki/Q42213","display_name":"Work (physics)","level":2,"score":0.2648000121116638},{"id":"https://openalex.org/C3017624810","wikidata":"https://www.wikidata.org/wiki/Q3259564","display_name":"Hospital discharge","level":2,"score":0.26339998841285706},{"id":"https://openalex.org/C148220186","wikidata":"https://www.wikidata.org/wiki/Q7111912","display_name":"Outcome (game theory)","level":2,"score":0.25619998574256897},{"id":"https://openalex.org/C2776376669","wikidata":"https://www.wikidata.org/wiki/Q5094647","display_name":"Intensive care unit","level":2,"score":0.2529999911785126},{"id":"https://openalex.org/C3019440749","wikidata":"https://www.wikidata.org/wiki/Q855172","display_name":"Noninvasive ventilation","level":3,"score":0.25110000371932983}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.09.07.26362407","doi":"https://doi.org/10.64898/2026.09.07.26362407","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.07.26362407","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/08/2026.09.07.26362407.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.09.07.26362407","doi":"https://doi.org/10.64898/2026.09.07.26362407","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.07.26362407","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/08/2026.09.07.26362407.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3","score":0.98580002784729}],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7212009727.pdf","grobid_xml":"https://content.openalex.org/works/W7212009727.grobid-xml"},"referenced_works_count":7,"referenced_works":["https://openalex.org/W2146855196","https://openalex.org/W2149860264","https://openalex.org/W2162800060","https://openalex.org/W2891400669","https://openalex.org/W4235169531","https://openalex.org/W4313439128","https://openalex.org/W7204944232"],"related_works":["https://openalex.org/W7204944232","https://openalex.org/W7222944965","https://openalex.org/W7214078338","https://openalex.org/W7213460068","https://openalex.org/W2785720656","https://openalex.org/W7127644497","https://openalex.org/W7169855444","https://openalex.org/W7220860319","https://openalex.org/W3128710449","https://openalex.org/W2028544996"],"abstract_inverted_index":{"Abstract":[0],"Objective":[1],"Four":[2],"dynamic":[3],"clinical":[4],"states":[5,237],"were":[6,59,117,145],"identified":[7],"in":[8,17,44,108,119,191],"the":[9,32,66,109,128,186],"first":[10],"72":[11],"h":[12],"of":[13,130,151,235],"stroke":[14],"intensive":[15],"care":[16],"one":[18],"centre.":[19],"We":[20],"tested":[21],"whether":[22],"this":[23],"representation":[24,198],"transports":[25,199],"to":[26,82],"an":[27],"independent":[28,243],"multicentre":[29],"cohort,":[30],"predicts":[31],"next":[33],"state,":[34],"and":[35,40,56,71,86,99,139,200,242,247],"is":[36,205,212],"independently":[37],"recovered.":[38],"Materials":[39],"Methods":[41],"8279":[42],"adults":[43],"176":[45],"hospitals":[46],"(eICU-CRD":[47],"v2.0)":[48],"contributed":[49],"70":[50],"630":[51],"six-hour":[52],"windows.":[53],"Phenotype,":[54],"dictionaries":[55],"eligibility":[57],"rules":[58],"frozen":[60],"before":[61],"any":[62],"state":[63,81,211],"was":[64,68,90,104,155],"assigned;":[65],"model":[67,103],"applied":[69],"unchanged":[70],"judged":[72],"against":[73,92],"five":[74,114],"prespecified":[75],"criteria.":[76],"Generalised":[77],"estimating":[78],"equations":[79],"related":[80],"subsequent":[83],"organ":[84,231],"support":[85],"ICU":[87,140],"death;":[88,141],"prediction":[89,154],"assessed":[91],"a":[93,102,215,218],"persistence":[94],"null":[95],"at":[96],"6,":[97],"12":[98],"24":[100],"h;":[101],"fitted":[105],"de":[106,169],"novo":[107],"strictest":[110],"scope.":[111],"Results":[112],"All":[113,123],"transportability":[115],"criteria":[116],"met":[118],"all":[120],"four":[121,173,236],"scopes.":[122],"nine":[124],"state\u2013outcome":[125],"comparisons":[126],"reproduced":[127],"direction":[129],"association,":[131],"with":[132,229],"exact":[133],"rank":[134],"order":[135],"for":[136],"invasive":[137],"ventilation":[138],"between-hospital":[142],"intraclass":[143],"correlations":[144],"0.012\u20130.027.":[146],"States":[147],"persisted":[148],"across":[149],"90.7%":[150],"pairs,":[152],"so":[153],"scored":[156],"on":[157],"change:":[158],"AUROC":[159],"(95%":[160],"CI)":[161],"0.730":[162],"(0.723\u20130.736)":[163],"externally,":[164],"0.735":[165],"(0.721\u20130.749)":[166],"internally.":[167],"Fitted":[168],"novo,":[170],"eICU":[171,220],"favoured":[172],"by":[174,178,214],"BIC":[175],"but":[176,204,225],"three":[177,188],"restart":[179],"reproducibility;":[180],"neither":[181],"recovered":[182],"neurological":[183],"impairment\u2013low":[184],"support,":[185],"other":[187],"matched":[189],"closely":[190],"both":[192],"(r":[193],"=":[194],"0.962\u20130.991).":[195],"Discussion":[196],"The":[197,209],"carries":[201],"forward-looking":[202],"information":[203],"not":[206,217],"fully":[207],"rediscoverable.":[208],"unrecovered":[210],"defined":[213],"combination,":[216],"feature:":[219],"places":[221],"its":[222],"windows":[223],"consistently":[224],"never":[226],"pairs":[227],"impairment":[228],"absent":[230],"support.":[232],"Conclusion":[233],"Three":[234],"are":[238,245],"strongly":[239],"supported.":[240],"Transportability":[241],"rediscovery":[244],"distinct":[246],"should":[248],"be":[249],"reported":[250],"separately.":[251]},"counts_by_year":[{"year":2026,"cited_by_count":1}],"updated_date":"2026-11-09T13:22:03.289127","created_date":"2026-09-10T00:00:00"}
