114: Use of Soft Tissue Neck Radiographs in Pediatric Acute Airway Obstructions: Current Perspective
Notice bibliographique
Résumé
Soft tissue neck radiographs (STNRs) have always been recognized as a helpful tool to differentiate benign causes of acute upper airway obstructions (AUAO) from epiglottitis, retropharyngeal abscess or foreign body aspiration among children. Based on the frequency at which some of those life-threatening pathologies now occur, are STNRs still widely used, at which intent and what is the impact of their clinical use? A retrospective, observational study was conduct to examine STNR use and usefulness in the pediatric population. All the medical files from children zero to 17 years of age who had a STNR between January 1, 2010 and December 31, 2011 in a mid-size Canadian university pediatric hospital were reviewed. STNRs were identified using the hospital electronic radiologic studies database. From all STNRs, those performed in an AUAO context were analyzed. Patient's characteristics, symptomatology, likely diagnosis before STNRs, and final interpretations by radiologists were collected. To evaluate the value of STNR regarding AUAO, patients were divided in two groups according to the conditions clinicians first suspected (benign vs. life-threatening: retropharyngeal abscess/epiglottitis/bacterial tracheitis/foreign body aspiration) and compared the STNRs' interpretations with Fisher exact test. In addition, based on discharge diagnosis from hospitalisation charts, cases of epiglottitis and retropharyngeal abscess for the same period were reviewed. Among 520 STNRs identified, 88% intended to evaluate AUAO among children (2010, n=231; 2011, n=226). Nearly all (99%) took place at the emergency room, with 73% of patients presenting with triage score 3 and above, and 49% necessitating admission. Most STNR were performed among males (67%) younger than five years of age (66%; mode one year of age). A life-threatening cause of AUAO was first suspected by clinicians among 40% of reviewed charts. However, convincing radiologic signs of life-threatening pathologies were only found in 40 children (9%), with no significant statistical difference based on clinicians' suspicions (11% for life-threatening vs. 7% for benign conditions suspected; P=0.128). Overall, two cases of epiglottitis and eight retropharyngeal abscesses were diagnosed during the study period, among which four of five STNR were positive. STNR is a radiologic study that is frequently used among children, mostly in the context of moderate to severe AUAO. The current value of STNRs appears uncertain as few showed solid evidences that may modify how clinicians currently manage pediatric AUAO.
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 | 0,001 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 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 ».