P-174 A Proposed Algorithm to Manage Pediatric Crohnʼs Related Intraabdominal and Pelvic Abscesses
Bibliographic record
Abstract
Five percent of children with Crohn’s disease present with penetrating disease under the B3 Montreal classification which excludes perianal fistula (1,2). The proportion of children with B3 behavior increases 15% at 10 years from diagnosis (3). Penetrating behavior results in intraabdominal and pelvic abscesses which necessitate emergent and inpatient care. The management of these complications is rife with variation in the absence of evidence based guidelines. Common major variation areas are: imaging modalities at presentation, choice of antibiotics, duration of antibiotics, pain management, decision to drain an abscess or not, method of drainage and duration, timing and method of reimaging, decision to allow enteral intake or not, decision to start parenteral nutrition, timing of the switch to oral antibiotics and considering antiinflammatory therapy versus surgery. As improvement in any process begins first with standardization, there is a clear need for a standardized approach to managing Crohn’s related abdominal and pelvic abscesses in children. Standardization affords us the ability to monitor outcomes and adjust our processes. 1. Satsangi J et al. Gut 2006;55:749–753. 2. De Bie CL et al. Inflamm Bowel Dis. 2013 Feb;19(2):378-385. 3. Vernier–Massouille et al. Gastroenterology 2008;135:1106–1113. As part of an institutional effort to standardize inpatient care, we developed a pathway to guide management of children with Crohn’s related abdominal and pelvic abscesses. We reviewed the available relevant literature for management recommendations. When no guideline or strong evidence was available, we obtained consensus from different relevant disciplines at our institution including pediatric gastroenterology, surgery, interventional radiology, infectious diseases, pharmacy, pain management and nutrition. An algorithm is presented (Fig.) with specific recommendations on initial imaging, criteria for abscess drainage, selection and duration of antibiotics, abscess drainage options, pain management plan, timing and type of follow up imaging, approach to enteral versus intravenous nutrition and discharge criteria. The project design entails detailed metrics to study subsequent outcomes and allow informed improvements in the future. Specific outcomes are: duration of hospitalization, success or failure of enteral intake, adequacy of the proposed 6 days of intravenous antibiotics, readmission rate. We propose a comprehensive algorithm to standardize the management of children with Crohn’s related abdominal and pelvic abscesses. Outcome metrics will be continuously evaluated to adjust the algorithm and improve outcomes.
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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 | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.004 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.022 | 0.011 |
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".