L'incertitude diagnostique lors de consultation pour boiterie du membre pelvien chez le chien : étude rétrospective sur 321 chiens présentés au ChuvA
Notice bibliographique
Résumé
Diagnostic uncertainty (DU) can be define as a « subjective perception of an inability to provide an accurate explanation of the patient's health problem ». This concept is very common in human medicine and is discussed in many publications for its consequences, but also its management and the communication that it requires. The purpose of this project consisted in assessing the DU further to consultations for dog's hind limb lameness and the prevalence of the various considered affections, and to identify clinical or epidemiological criteria that may contribute to a diagnostic. Long bone fractures, wounds and abscesses were discarded. 321 dogs presented at the ChuvA between January 1st 2020 and February 28th 2021 met those criteria and were analyzed. Age, sex, weight, breed, degree of lameness, and results of orthopedic and complementary examinations were recorded for each dog. A definitive diagnosis was determined for 62% among 321 cases. The remaining 38% showed a DU related to a suspicion of a given affection, a hesitation between two affections or a lack of diagnostic hypothesis. The 3 diseases with the most definitive diagnosis were cranial cruciate ligament ruptures (CCLR) for 61.9%, patellar luxations (PL) for 24.3% and hip dysplasia (HD) for 20.6%. CCLR occurred more to dogs heavier than 20 kg (x1.42) and whose lameness degree was higher than 2 (x1.31). Labrador Retrievers, Yorkshire Terriers and Jack Russel Terriers as well as sterilized dogs were predisposed. The criterion which was the most associated with a diagnosis of CCLR was the presence of a positive drawer sign (definitive CCLR diagnosis is 4.44 better than without this sign) followed by the stifle thickness (x1.98). Yorkshire Terriers and Jack Russel Terriers were more often affected by PL (x3.6 and x2.41 respectively) than other dogs. Small dogs (lighter than 20 kg) were predisposed (x4.37). Labrador Retrievers, Belgian Malinois and American Staffordshire Terriers were under-represented (No PL for any of them). The criterion which was the most associated with a diagnosis of PL was the presence of patellar instability (x72.3 more PL diagnostic than without patellar instability). Finally, Labrador Retrievers and German Shepherds were more affected by HD (x2.4 and x4.99 respectively). It seems that HD is clinically expressed by mild to moderate lameness as it was more observed (x2.92) on dogs whose lameness degree was lower than 2/5. Pain on palpation-pressure of the pectineal muscles, abduction or hyperextension of the hip, was predictive of a HD diagnostic.
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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 | 0,028 | 0,032 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,003 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,005 | 0,002 |
| Intégrité de la recherche | 0,000 | 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 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 ».