112 The Additive Value of Nuclear Medicine Shuntograms to Computed Tomography for Suspected Cerebrospinal Fluid Shunt Obstruction in the Pediatric Emergency Department
Notice bibliographique
Résumé
The diagnostic evaluation of children with suspected cerebrospinal (CSF) obstruction is a complex evaluation facing pediatric emergency physicians frequently. Traditionally, radiographic studies including both radiographs (shunt series) and computed tomography (CT) have been performed. Nuclear medicine studies (CSF shuntograms) are dynamic studies that potentially can identify and localize the presence of a CSF shunt obstruction. This information can assist the neurosurgeon tremendously. To measure the predictive value of nuclear medicine studies (CSF shuntograms) and radiographic studies (CT scans) in a cohort of children undergoing evaluation for suspected shunt obstruction in a tertiary care pediatric emergency department. A retrospective chart review was conducted on patients under the age of eighteen years who presented to the Pediatric Emergency Department (ED) of the Children's Hospital of Western Ontario and had both computed tomography (CT) of the head and a CSF shuntogram ordered by the attending pediatric emergency medicine physician between December, 1998 and April, 2003. Nuclear medicine and radiological reports were reviewed for all patients presenting to the ED with suspected shunt obstruction. Three independent investigators interpreted these investigations as normal, inconclusive or abnormal, or inconclusive. Inconclusive investigations were considered to be abnormal in the data analysis. The a priori kappa level of agreement between the three investigators was excellent (kappa=1). A total of 69 patients were evaluated for suspected shunt obstruction during this time period with both CT and CSF shuntogram. Twenty-six (37.7 %) patients subsequently required corrective surgery for suspected shunt obstruction which was confirmed intra-operatively. The CT scans showed abnormalities suggestive of CSF shunt obstruction in 20 of the patients that required surgery (sensitivity, 77%; negative predictive value, 82%) while CSF shuntograms showed abnormalities suggestive of CSF obstruction in 24 of the patients that required surgery (sensitivity, 92%; negative predictive value, 93%). CT scans and shuntograms combined revealed abnormalities suggestive of CSF shunt obstruction in 25 of the 26 patients who required surgery (sensitivity, 96%; negative predictive value, 97%) Over one-third of pediatric ED patients evaluated with CT and CSF shuntograms required surgical management. Both sensitivity and negative predictive values were increased with CT and CSF shuntogram compared to CT alone. Prospective studies are required to assess the use of radiographic and nuclear medicine tests for shunt evaluation in conjunction to the development of a clinical prediction rule for the pediatric emergency physician.
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 | 0,003 | 0,025 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
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 ».