A pilot study to assess feasibility of evaluating the safety and efficiency of a simplified diagnostic approach for pulmonary embolism
Notice bibliographique
Résumé
Background: Decision rules designed to reduce the need for pulmonary embolism (PE) imaging are seldom used by emergency physicians because of their complexity and poor credibility. We designed a simple, modified age-adjusted decision rule for PE testing in the emergency department (ED) – the ‘Adjust-Unlikely’ rule. Given increasing pressure on EDs, alternative methods to in-person recruitment are needed to validate the diagnostic performance of the Adjust-Unlikely rule in a full-scale study. Objectives: The primary objective of this research was to assess the feasibility of a protocol consenting patients tested for suspected PE with the Adjust-Unlikely rule by telephone after they left the ED. The secondary objectives were to estimate safety and efficiency of the Adjust-Unlikely rule for diagnosing PE in the ED and to assess whether our methods introduced spectrum bias. Methods: A prospective management pilot study was conducted in one ED and one urgent care centre. Adult patients tested for PE using the Adjust-Unlikely rule were recruited by telephone and followed for 90 days to identify subsequent testing for venous thromboembolism. PE and deep vein thrombosis (DVT) testing during follow-up was independently adjudicated. The feasibility outcomes were recruitment rate, missed eligible rate and overall follow-up rate. To assess for spectrum bias, multivariable logistic regression was used to compare included patients to missed eligible patients and patients who declined participation. Results: Two hundred patients were included. On average, 9 patients were recruited per site, per week and 6 patients were missed per site, per week. The overall follow-up rate was 96.5%. Of the 143 patients with a negative Adjust-Unlikely rule on index visit, 1 patient was diagnosed with PE during follow-up. We found evidence of spectrum bias in our study population. Female patients and older patients were over-represented in our study population compared to patients who were eligible but not included. Conclusions: Telephone recruitment did not meet our predefined thresholds for feasibility. This research has informed the design and planning of a full-scale study that will prospectively validate the safety and efficiency of the Adjust-Unlikely rule for diagnosing PE in the ED across Ontario.
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 | 0,053 | 0,071 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,001 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 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 ».