The Effect of Picture Archiving and Communications Systems on the Accuracy of Diagnostic Interpretation of Pediatric Emergency Physicians
Bibliographic record
Abstract
OBJECTIVES: To compare the accuracy of diagnostic interpretation of radiographs by pediatric emergency physicians (EPs) before and after the introduction of a Picture Archiving and Communications System (PACS). METHODS: The pre-PACS study period included results from September 2001, when patients were evaluated by using only conventional radiographs. The post-PACS study period consisted of results from September 2002, when patients were evaluated by using only digital radiographic studies. During these periods, consecutive medical records of all patients who underwent radiological studies when attending the pediatric emergency department (ED) were reviewed. The radiographic interpretation by the pediatric EP, documented at the time of the ED visit, was compared with that made by the pediatric radiologist. RESULTS: Data were available from 1,644/1,651 sets of conventional radiographs ordered for the pre-PACS study period and from 1,430/1,431 sets of digital radiographic studies for the post-PACS study period. The prevalence of positive radiological studies as per the radiologists was 32.2% (pre-PACS study period) vs. 28.7% (post-PACS study period). Diagnostic performance of the pediatric EPs for the two time periods was as follows: overall accuracy, 98.1% (95% confidence interval [CI] = 94.5% to 100%) vs. 98.5% (95% CI = 87.5% to 100%); sensitivity, 96.4% (95% CI = 94.5% to 97.8%) vs. 98.1% (95% CI = 96.2% to 99.2%); specificity, 98.9% (95% CI = 98.1% to 99.4%) vs. 98.6% (95% CI = 97.7% to 99.3%); negative predictive value, 98.3% (95% CI = 97.4% to 99.0%) vs. 99.2% (95% CI = 98.5% to 99.7%); and positive predictive value, 97.7% (95% CI = 96.0% to 98.8%) vs. 96.6% (95% CI = 94.4% to 98.2%). The proportion of false negatives (FN) was 1.2% (19/1,644) vs. 0.6% (8/1,430). Only one FN patient for each time period required immediate follow-up for a missed diagnosis. CONCLUSIONS: Radiograph interpretations by pediatric EPs with digital studies remain as accurate in comparison with assessments performed by using conventional radiographs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.027 | 0.264 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".