Five-year incidence of surgery in a prospectively followed cohort of pediatric patients with Crohnʼs Disease
Bibliographic record
Abstract
An inception cohort of pediatric Crohn's disease (CD) patients is being prospectively followed to determine the contemporary natural history of CD within members of the Pediatric IBD Collaborative Research Group (PIBDCRG). There has been an increase in the use of immunomodulators and biologics in pediatric CD over the last decade1,2 that may decrease a pediatric CD patient's risk for bowel surgery. Previous studies reflect the incidence of bowel surgery in pediatric CD patients diagnosed prior to 20033,4,5 and may not reflect these changes in medical management. The PIBDCRG Registry database was examined to determine the contemporary incidence of bowel surgery, as well as all CD-related surgery (including abscess drainages), in a multi-center prospectively followed cohort of pediatric CD patients diagnosed between 2002 and 2008. In addition, disease characteristics were analyzed to evaluate for the risk of bowel surgery. Of 854 patients with CD (mean 12 years old, 42% female, mean follow-up of 2.3 years), 57 (7%) underwent a first bowel surgery (bowel resection, ostomy, strictureplasty, or appendectomy) and 19 (2%) underwent a first non-bowel surgery (abscess drainage or fistulotomy). Overall, 76 (9%) underwent a first CD-related surgery. The cumulative risk of bowel surgery, non-bowel surgery, and all CD-related surgery was 3.4%, 1.4%, and 4.8% respectively at 1 year after diagnosis and 13.8%, 4.5%, and 17.7% respectively at 5 years after diagnosis. Older age at diagnosis, greater disease severity, stricturing or penetrating disease increased the risk of bowel surgery. Disease between the transverse colon and rectum decreased the risk of bowel surgery. Gender, race, family history of IBD, and large bowel disease did not influence the risk of bowel surgery. In our prospective CD cohort the five-year cumulative risk of bowel surgery was markedly lower than recent studies of adult and pediatric patients,3,4,6,7 but similar to one recent retrospective pediatric study.5 Strategies to identify phenotypes associated with stricturing and penetrating disease and preventing these complications are needed.
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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 | 0.002 |
| 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 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 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".