193: Identifying Radiologic Signs of Life-Threatening Causes of Acute Upper Airway Obstruction in Children: Not That Easy!
Bibliographic record
Abstract
Soft tissue neck radiographs (STNRs) are viewed as a helpful tool to investigate causes of acute upper airway obstructions (AUAO) among children. Some findings on STNR guide clinicians in identifying life-threatening causes of AUAO such as epiglottitis, retropharyngeal abscess or foreign body aspiration. Do the clinicians are skilled enough to recognize those radiologic signs? A retrospective, observational study was conduct to examine STNR use in the pediatric population. The medical files from children aged 0 to 17 who had a STNR between January 1, 2010 and December 31, 2011 in Canadian university pediatric hospital were reviewed. STNRs were identified using the hospital electronic radiologic studies database. From all STNRs, only those performed in an AUAO context were analyzed. We collected data about clinicians' (emergency physicians, pediatricians, ENT specialists) and radiologists' interpretations. Identification by clinicians of significant findings on STNRs related to life-threatening causes of AUAO (swollen epiglottis or aryepiglottic, swelling of the retropharyngeal space, decrease tracheal diameter/tracheal deviation, and presence of a foreign body) were compared to radiologists' reports (gold-standard) to establish their global and individual sensibility and specificity. Kappa coefficients were determined to describe inter-rater agreement on SNRT findings, with scores >0.75 depicting excellent agreement, 0.40 to 0.75 fair to good, and <0.40 poor. The frequency at which SNRTs were described as technically inadequate by radiologists was also analyzed. Among 457 STNRs intended to evaluate AUAO among children, 11% (n=52) showed significant findings of life-threatening causes of AUAO according to clinicians, compared to 17% (n=77) according to radiologists (global sensibility=35%, specificity=93%; kappa=0.327). Respectively, sensibility and specificity vastly differed according to signs evaluated: 26% and 97%, kappa=0.27 for swollen epiglottis/aryepiglottic edema (n=23 according to radiologists); 37% and 96%, kappa=0.37 for swelling of the retropharyngeal space (n=38); 0% and 99% kappa=−0.01 for decrease tracheal diameter/tracheal deviation (n=16); 100% and 99%, kappa=0.86 for the presence of a foreign body (n=3). Moreover, 15% of SNRTs were described as technically inadequate by radiologists. Overall, the identification of life-threatening causes of AUAO on STNRs in the pediatric population appears quite challenging for clinicians. Furthermore, SNRTs are technically difficult to perform among children. Some radiological findings seemed easier to identify. Owing to those difficulties, physicians' training in interpreting SNRTs and the importance of STNRs in evaluating AUAO among children need to be reassessed.
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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 | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".