Are Occult Pneumothoraces Truly Occult or Simply Missed?
Bibliographic record
Abstract
BACKGROUND: Nonradiologists typically diagnose pneumothoraces (PTX) based on a visible pleural stripe. PTXs not seen on supine AP chest radiographs (CXR), but appreciated on a computed tomographic (CT) scan, termed occult pneumothoraces (OPTX), are increasingly common. The purpose was to (1) determine whether perceived OPTXs were truly occult or simply missed and (2) address factors that contribute to the poor sensitivity of the supine CXR. METHODS: A previous study of severely injured patients (ISS >or =12) identified 44 patients with OPTXs. JPEG images of these CXRs were randomly arranged with images of 11 injured patients without PTXs (CT proven). Three unique groups of radiologists reviewed the images for signs of PTXs, and determined if a thoracic CT was subsequently required. RESULTS: Retrospective review identified only 12 to 24% of the OPTXs depending on radiology group. The kappa inter-observer agreement value was 0.55 to 0.56 (poor agreement). PTXs were most commonly identified via the deep sulcus sign (75-90%). CXRs were considered inadequate in 16 to 25% of OPTX images and in 0 to 18% of images without OPTXs. Thoracic CT scans were recommended in 18 to 33% of patients with inadequate CXRs, but 67 to 82% of patients with adequate CXRs. CONCLUSIONS: Less than 24% of all OPTXs might have been inferred from subtle radiologic findings, such as the deep sulcus sign. The majority of OPTX cases (50-64%) did not warrant a CT scan based on other findings. Concern for an OPTX after severe trauma is a valid indication for thoracic CT.
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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 | 0.003 | 0.045 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| 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".