Prospective Evaluation of the Prevalence of Pulmonary Embolism in Patients with Chronic Obstructive Pulmonary Disease Exacerbation: Challenges and Feasibility
Notice bibliographique
Résumé
Introduction: Data on the prevalence of pulmonary embolism (PE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in North America is lacking, with most of the prospective studies conducted in Europe and Asia. The aim of this study is to describe feasibility of prospective collection of data evaluating the prevalence of PE in patients admitted for AECOPD in Canada, and to describe challenges of this approach. Methods: This is a secondary analysis of a prospective pilot patient cohort aiming to assess the diagnosis of AECOPD among hospitalized patients. Items of the Wells PE and revised Geneva scores were prospectively collected. All patients underwent D-dimer testing within 24 hours of admission. All patients were followed for 3 months. Feasibility outcomes were prospective data collection to evaluate the prevalence of PE, D-dimer level measurement and 3-month follow-up. The study was considered feasible if >=90% of the patients had prospective data collected to assess the prevalence of PE, >=80% of the patients had D-dimer level measured and their 3-month follow-up, respectively. Challenges were also assessed. Results: Twenty patients were included. According to the Wells PE score, 16 (80.0%), 4 (20.0%) and 0 (0.0%) patients had low, moderate and high clinical pre-test probability (c-PTP), respectively. According to the revised Geneva score, 2 (10.0%), 17 (85.0%) and 1 (5.0%) patients had low, intermediate and high c-PTP, respectively. Based on age-adjusted D-dimer cut-off, 7 and 11 patients had negative and positive D-dimer, respectively. All patients (100.0%) had prospective data collection to assess the prevalence of PE. D-dimer level was available for 18/20 (90.0%) patients and 3-month follow-up evaluation was performed in 16/20 (80.0%) patients. Challenges included the difficulty in recruiting patients since it is a population with many comorbidities, adequate c-PTP assessment using validated clinical decision rules, absence of consistent PE diagnostic strategy use since patients were mostly investigated according to the physician's impression and adequate 3-month follow-up since 25% of the patients had some protocol deviation for the follow-up. No PE was diagnosed during the entire study period. Conclusion: This pilot study shows the feasibility in prospectively collecting data to evaluate the prevalence of PE in patients admitted for AECOPD in Canada. Also, challenges were assessed and included recruitment of patients, adequate c-PTP assessment, consistent PE diagnostic strategy use and adequate 3-month follow-up.
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 | 0,023 | 0,029 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 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 ».