Bibliographic record
Abstract
INTRODUCTION Nephrotic syndrome is a common childhood acquired kidney disease, characterized by proteinuria and edema. It can have a variety of complications, including thromboembolic events and end-stage renal failure. Despite knowledge of symptoms, treatment and complications, the clinical experience of nephrologists at the Alberta Children’s Hospital suggests that there are delays in diagnosis and mistakes in treatment, due to the relative non-specificity of the symptoms. Delays and mistakes in treatment could have consequences including increased complications, higher costs of treatment and alteration of the clinical course of the syndrome. As it is unclear why these errors occur, it is important to determine what factors impact delays in diagnosis, whether or not any of these factors are modifiable and what actions could be taken to avoid misdiagnoses and delays. The objective of this study was to determine what healthcare use occurred prior to diagnosis of nephrotic syndrome to see what factors impact delays in diagnosis and whether these factors are modifiable. METHODS The study design was a phone or in-person survey, approximately 15 minutes in length, conducted with the legal guardians of children between the ages of 1 and 18 who have been diagnosed with nephrotic syndrome in the Calgary area and have been seen at the Alberta Children’s Hospital Nephrology Clinic within the past 12 months. The survey was composed of 3 sections, examining patient level variables, healthcare history, and information specific to the family. RESULTS The study showed a diagnosis delay range of 1 day to approximately 110 days. All families reported that once a urine test was completed, a correct diagnosis was obtained. A total of 12 participants were included, with an age range 2.8-11.4 years. The majority of the participants were male, had no pre-existing food allergies, and came from a family where the combined household income before taxes was greater than $100,000. Additionally, participants were of varying ethnic origins. When comparing number of visits to specific healthcare locations and number of wrong diagnoses given, results showed a high rate of diagnostic success in the ER: 11% of patients were given a wrong diagnosis. In contrast, family doctor achieved a low rate of diagnostic success: 100% of patients were given a wrong diagnosis. These wrong diagnoses varied, including constipation and pink eye, but the most common error was diagnosis of allergies, which constituted 61% of faulty diagnoses. DISCUSSION AND CONCLUSIONS Nephrotic syndrome is commonly misdiagnosed by family doctors, resulting in delayed treatment. Given the results that diagnostic success was high in the ER, where a urinalysis was almost always used, the low rate of successful diagnosis by family doctors can be avoided. There appears to be a need to further educate physicians on the importance of using a urine analysis. Furthermore, future research may explore the value of tools as a reminder to physicians and families that symptoms such as puffy eyes can be indicator of nephrotic syndrome and not necessarily allergies.
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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 | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| 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".