4Ts HIT Scoring in the Medical-Surgical ICU
Bibliographic record
Abstract
Abstract Abstract 4669 Background: Thrombocytopenia occurs in 20–45% of critically-ill medical-surgical patients. The ‘4Ts’ HIT score (with 4 domains: Thrombocytopenia, Timing of thrombocytopenia, Thrombosis and oTher reason for thrombocytopenia) might reliably identify patients at low risk of HIT. Agreement on 4Ts scoring is uncertain in this setting. Objective: To compare 4Ts HIT scores among research coordinators (who scored real-time), and 2 adjudicators (who scored retrospectively, independently) during an international heparin thromboprophylaxis trial. Methods: 763 of 3746 medical-surgical ICU patients in PROTECT met enrolment criteria in this HIT substudy, if any of the following occurred: platelets <50×109/L, platelets decreased to 50% of ICU admission value, venous thrombosis, or if HIT was otherwise clinically suspected. Persons independently completed 4Ts scores blinded to all laboratory HIT results and each others' scores. 475 of these patients had a central or local laboratory HIT test performed and had 4Ts scoring by adjudicators; 432 were scored by research coordinators. Results: Most patients (410, 86.3%) had a 4Ts score ≤3 conferring a low pretest probability (PTP) of HIT whereas 57 (12.0%) had a moderate PTP, and 8 (1.7%) had a high PTP, as determined by adjudicator consensus. Raw agreement on the 4Ts score was good for central adjudicators overall; however, agreement between adjudicated consensus scores and real time research coordinator scores was not as high. 4Ts agreement (raw and chance-corrected) is presented below. Conclusions: Real time 4Ts scoring by research coordinators was reasonably close to that obtained by calibrated central adjudicators, suggesting the 4Ts score is somewhat reliable at the bedside when performed by trained personnel. The fourth domain of 4Ts (oTher causes of thrombocytopenia) generated the most disagreement. Further studies of 4Ts scoring by bedside clinicians is needed. Funding: Heart and Stroke Foundation of Canada Disclosures: Crowther: Pfizer: Consultancy, Honoraria; Leo Pharma: Consultancy, Honoraria; Bayer: Consultancy, Honoraria; BI: Honoraria; CSL Behring: Consultancy; Octaphram: Consultancy; Artisan: Consultancy. Off Label Use: Dalterparin is not indicated for prolonged prophylaxis in critically ill medical patients. Zytaruk:Pfizer: donated study drug dalteparin for PROTECT. Cook:Pfizer: donated study drug dalteparin for PROTECT. Warkentin:Sanofi-Aventis: Speakers Bureau; Pfizer Canada: Speakers Bureau; GlaxoSmithKline: Consultancy, Research Funding; GTI Diagnostics: Consultancy, Research Funding; Canyon Pharma: Consultancy, Speakers Bureau; Informa: Patents & Royalties.
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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 | 0.006 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 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 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".