S1028 Validating a Patient Risk Assessment Tool to Predict Post-ERCP Pancreatitis and Assist Prophylactic Treatment Planning
Notice bibliographique
Résumé
Introduction: Post-ERCP pancreatitis (PEP) is a complication of ERCPs leading to significant patient morbidity and mortality. ASGE/ESGE guidelines recommend pancreatic duct stent placement, rectal indomethacin (IND), and/or fluid hydration with lactated Ringer’s (RL) or normal saline (NS) to prevent PEP. Recommendations regarding which treatment to use are often based on a patient’s PEP risk level and relevant comorbidities. To our knowledge, there is no objective calculator to aid in predicting PEP risk level for patients undergoing ERCP. Methods: Retrospective chart reviews of ERCP patients were completed within a single clinician’s practice at London Health Sciences Centre between 2016-2019. We developed a patient PEP risk screening tool based on ASGE/ESGE guidelines (Table 1) and analyzed its accuracy in predicting PEP in our practice. We then assessed the PEP rate for different PEP prophylactic treatments and determined whether these treatments were given according to the patient’s PEP risk level. Results: Five hundred sixty-one ERCP patients were assessed using the PEP risk screening tool with 6.6% (37/561) developing post-ERCP pancreatitis. A cut-off score totalling 1 for our tool was chosen to identify high PEP risk patients due to its high sensitivity and moderate specificity. Using the screening tool, 79.5% (446/561) were identified as high PEP risk. Patients receiving ERCP identified as high PEP risk by our tool were roughly 4 times more likely to go on to develop PEP (OR 4.81, [CI] 1.14-20.31). PEP rates were highest in patients who received pancreatic stenting (16.7%) or IND (8.8%) +/- RL (11.2%). Using the risk screening tool, all patients receiving pancreatic stenting were deemed high PEP risk and high PEP risk patients were roughly twice as likely to receive IND (OR 2.09, [CI] 1.36-3.21) compared to low PEP risk patients. Conclusion: Overall, our PEP risk screening tool was very sensitive at identifying patients who were likely to develop PEP. Patients with a higher risk level received more extensive prophylactic treatments as expected. The observed elevated post-ERCP pancreatitis rates in patients receiving these treatments might be partially explained by the higher average PEP risk level in these patients. We hope, high-risk patient identification can be improved prior to ERCP, to provide more objective risk level stratification to better assess PEP prophylactic treatment efficacy moving forward.Table 1.: Post-ERCP Pancreatitis (PEP) Risk Screening Tool Based on ASGE and ESGE Guidelines.
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 distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 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) | 0,000 | 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 tête enseignante, 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 ».