Bibliographic record
Abstract
Source:Boutis K, Komar L, Jaramillo D, et al. Sensitivity of a clinical examination to predict need for radiography in children with ankle injuries: a prospective study. Lancet. 2001;358:2118–2121.Radiographs are frequently ordered for children presenting with an ankle injury. Investigators from Boston and Toronto assessed the predictive value of the clinical examination to de. ne a low-risk group whose management would not be affected by the absence of a radiograph. They hypothesized that no more than 1% of children with low-risk exams (de. ned as pain and/or tenderness with or without edema or ecchymoses restricted to the distal fibula, the 3 adjacent ligaments, or both) would have fractures at risk of complications. (Potentially uncomplicated fractures included all except avulsion, buckle, and non-displaced Salter-Harris I and II fractures of distal fibula). They also compared the accuracy of their low-risk criteria with the Ottawa ankle rules (radiographs required only if there is pain near the malleoli accompanied by 1 or more of the following: inability to bear weight; bone tenderness at the posterior edge; or bone tenderness at the tip of either malleolus).1Clinical examinations and subsequent radiographs were prospectively and independently evaluated in 2 pediatric emergency departments among healthy 3- to 16-year-old children with acute ankle injuries. Of 607 enrolled children, 381 had low-risk and 226 had high-risk clinical examinations. None of the 381 children with low-risk examinations had a high-risk fracture (negative predictive value 100%; 95% CI, 99.2-100). Of 226 children with high-risk clinical examinations, 45 had a signi. cant fracture (positive predictive value 20%; 95% CI, 14.9-25.7). Using the proposed low-risk criteria, the ankle examination has a sensitivity of 100% (95% CI, 93.3-100) and a speci. city of 68%. If these criteria were applied, radiographs could be omitted in 63% of children with ankle injuries compared to a 12% reduction using the Ottawa ankle rules.This study shows that a clinical exam can successfully predict which children can avoid radiography following ankle trauma. Their exam criteria are simpler than the previously described Ottawa ankle rules1 and were more effective in reducing the number of radiographs. The investigators point out that their findings may not apply to clinicians with less training and experience in the clinical examination of children’s ankles. Most pediatricians should be able to apply this test and avoid unnecessary ankle x-rays.It is important to recognize that a low-risk examination using the proposed criteria does not rule out an ankle fracture, but it does provide assurance that if a fracture is present it is unlikely to be unstable or at risk for complications. There remains some controversy about how best to manage this low-risk group, but all would agree that close follow-up is essential.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".