Post-Thrombotic Syndrome in Pediatrics: Development of a Measurement Index
Bibliographic record
Abstract
Objectives: Post-thrombotic syndrome (PTS) is the most common long-term complication of upper and lower extremity (UE/LE) deep vein thrombosis (DVT). The objective of this thesis was to develop an index for diagnosis and severity rating of pediatric PTS. \nMethods: Separate sub-indexes were developed for UE and LE. First, a preliminary study was conducted to determine normal values of limb fluid content in children, using bioimpedance spectroscopy (BIS, Study 1); this information was used for item piloting in Study 2. Next, the signs and symptoms (items) to be included in each sub-index were obtained from a survey answered by an international panel of pediatric thrombosis experts and interviews to pediatric patients with PTS; the items were then defined and piloted in children with UE or LE-DVT to test their diagnostic performance and correlation with PTS diagnosis and severity, assessed by a pediatric thrombosis expert (Study 2). Last, the final items of the sub-indexes were voted by the expert panel using a Delphi process; a scoring system was then developed taking into account item importance to health care providers and to patients/parents, using multiple-criteria decision analysis (MCDA); the meaning of the scores was explored by comparing scores with PTS diagnosis and with parental satisfaction/dissatisfaction with the clinical condition of their child (Study 3).\nResults: Normal BIS values were obtained from 223 healthy children. Twenty-three experts and 16 patients with PTS identified 34 items, 32 of which fitted our measurement framework and were tested in children with UE-DVT (n=70) or LE-DVT (n=70). Aided by the obtained information on the diagnostic performance of each item, the pediatric thrombosis experts voted to retain 10 and 7 items for the LE and UE sub-indexes, respectively (81% response rate). Item weights were developed using MCDA (122 participants, 82% response rate). Both sub-indexes showed good discriminative ability to differentiate between patients with and without PTS. Higher scores were associated with parental dissatisfaction with the clinical condition of their child. \nConclusion: We present an index for diagnosis and severity rating of pediatric PTS, developed using expert consensus. The tool provides a meaningful score and has proven diagnostic properties.
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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 | 0.001 | 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) | 0.011 | 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".