Get In Line: Queue Position is a Stronger Predictor of Adenoma Detection Than Morning or Afternoon Timing of Colonoscopy
Notice bibliographique
Résumé
Purpose: Physician fatigue may adversely affect adenoma detection rate (ADR). Queue position may account for differences in ADR that were previously attributed to the timing of colonoscopy. We aim to determine the role of queue position in the prediction of ADR. Methods: The study was approved by our institution's IRB. We prospectively enrolled patients undergoing outpatient colonoscopy in March and April of 2011. We used the medical record as well as a survey designed for the study to record information about patient demographics, bowel preparation, procedural indications and outcomes. Fisher's exact test and multivariate logistic regression were performed to determine the effects of age, gender, race, bowel preparation (using the validated Ottawa scale), indication for colonoscopy (screening vs. other), total colonoscopy time, timing of colonoscopy (morning vs. afternoon) and queue position (for each endoscopist) on ADR. Results: 125 patients were included in the study (mean age 60.0, 46.4% male). 9.6% were African American, 18.4% were Asian and 60.8% were Caucasian. 87.2% of bowel preps were excellent (total Ottawa score of 4 or less). 42.4% of procedures were done for screening purposes only. The average time for each procedure was 16.4 minutes, the average withdrawal time was 6.3 minutes and the cecal intubation rate was 100%. 67 procedures (53.6%) were performed before 12:00 pm. The average queue position was 3.0 (range 1-7). The overall ADR was 41.6%. In a univariate analysis, the first patient in the queue was more likely to have an adenoma removed than in all the other queue positions combined (56.7% vs. 36.8%, p=0.044, Fisher's exact test). After multivariate logistic regression, the first position in the queue was strongly associated with adenoma detection (p=0.050) while morning (vs. afternoon) colonoscopy was not (p=0.256). Among the other factors included in the multivariate analysis, total procedure time >20 minutes was significantly associated with adenoma detection (p=0.002) and age >65 showed a trend toward significance (p=0.065). Conclusion: In this small prospective study of patients undergoing outpatient colonoscopy, the first position in the queue was associated with a higher adenoma detection rate than all of the other queue positions while there was no difference between morning and afternoon start times. Our findings support recently published evidence that queue position may most accurately reflect physician fatigue during colonoscopy. Larger studies are necessary to further validate these findings.
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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 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 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 ».