DIAGNOSTIC SLEEP STUDIES IN CHILDREN WITH MEDICAL COMPLEXITY: DO THEY CHANGE MANAGEMENT?
Notice bibliographique
Résumé
BACKGROUND: Children with medical complexity (CMC) can be described by four characteristics: a chronic complex medical condition, severe functional limitations, substantial healthcare needs, and high healthcare utilization. CMC and their families are faced with countless medical tests and challenging treatment decisions. CMC are predisposed to sleep disordered breathing (SDB), as their conditions often affect the central nervous system, neuromuscular tone, and craniofacial structures. A polysomnogram (PSG) is the gold standard to diagnose and determine SDB severity. If SDB is diagnosed, treatment options are often invasive and may not be in the best interests of the child. As a result, outlining treatment options and understanding a family’s wishes prior to proceeding with a PSG is prudent. Sharing knowledge and decision-making with a family may decrease costs to both the child and the healthcare system. OBJECTIVES: Our aim was to: a) identify if SDB diagnosis in CMC impacts clinical care; b) explore whether or not families’ wishes were discussed prior to PSG completion. DESIGN/METHODS: Our Complex Care Database was searched for CMC who underwent a baseline PSG from January 1, 2009 to June 15, 2015. PSGs completed for follow-up or ventilation titration were excluded. Health records were reviewed to determine demographics, medical history, families’ wishes, PSG results, and their impact on clinical care. Descriptive statistics were used to summarize results. RESULTS: 181 patients were identified from the initial search; 96 patients met inclusion criteria. 48 (50%) were male. Mean (SD) age was 4.10 (3.97) years. 32 (33%) had moderate to severe obstructive apnea, 10 (10%) had moderate to severe central apnea, and 3 (3%) had both. Of those diagnosed, 9 had surgery, 23 had respiratory technology initiated and 3 had both surgery and respiratory technology initiated. 4 patients were urgently admitted to hospital. Only 3 out of 96 patients had clear documentation of their families’ wishes in regards to the PSG prior to its completion. CONCLUSION: Approximately one half of CMC referred for PSG had a diagnosis of clinically significant SDB. PSG results led to significant intervention in 78% of those diagnosed. Of those remaining, treatment options were either considered too risky, or did not align with the families’ wishes. Recognizing the burden of medical tests for both the child and the healthcare system, it is prudent to clarify a family’s wishes prior to conducting a PSG. Shared-decision making will help ensure clinical investigations and management remain in the best interests of the child.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,034 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».