128: Examining Agreement Between Treatment Recommendations from Different National Clinical Practice Guidelines for Bronchiolitis
Bibliographic record
Abstract
Guidelines give recommendations based on synthesis of evidence with the designed purpose to influence a physician's care of the patient. What is the degree of agreement between similar bronchiolitis treatment recommendations within different national guidelines? Guidelines were searched with MEDLINE, EMBASE, and the grey literature. Recommendations within each guideline were categorized as 1) recommend for 2) optionally recommend 3) abstain from recommending and 4) recommend against a treatment. The degree of agreement between recommendations was evaluated using a weighted Kappa score. Pairwise comparisons of the guidelines were evaluated similarly. There were five guidelines: American Academy of Pediatrics (AAP), Scottish Intercollegiate Guidelines Network (SIGN), Clinical Practice Guidelines in the Spanish National Healthcare System (Spain), Pediatric Society of New Zealand (NZ), and Australian Health for Kids Guideline Development Group (AUS). There were 95 recommendations with 25 recommendations given in >2 guidelines. The overall weighted Kappa score for the treatment recommendations was 0.91 (CI 0.82, 0.98). This demonstrates excellent agreement. Overall agreement between the pairs ranged from the lowest of 0.82 (CI 0.60, 1.00) between the AAP and NZ guidelines to the highest degree of agreement of 0.96 (CI 0.88, 1.00) between the SIGN and Spain guidelines. Overall, there was excellent agreement of the bronchiolitis treatment recommendations internationally. Evidence synthesis and guideline generation is labor intensive and expensive. Globalization of guidelines would conserve resources and allow for greater resource utilization for implementation of guidelines at the bedside.
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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 | 0.294 | 0.630 |
| Meta-epidemiology (narrow) | 0.001 | 0.002 |
| Meta-epidemiology (broad) | 0.005 | 0.009 |
| Bibliometrics | 0.027 | 0.022 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.006 | 0.007 |
| Open science | 0.004 | 0.006 |
| Research integrity | 0.003 | 0.003 |
| 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; the direct Gemma label and the distilled Codex classifier agree on what is shown here.
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".