112 The Additive Value of Nuclear Medicine Shuntograms to Computed Tomography for Suspected Cerebrospinal Fluid Shunt Obstruction in the Pediatric Emergency Department
Bibliographic record
Abstract
The diagnostic evaluation of children with suspected cerebrospinal (CSF) obstruction is a complex evaluation facing pediatric emergency physicians frequently. Traditionally, radiographic studies including both radiographs (shunt series) and computed tomography (CT) have been performed. Nuclear medicine studies (CSF shuntograms) are dynamic studies that potentially can identify and localize the presence of a CSF shunt obstruction. This information can assist the neurosurgeon tremendously. To measure the predictive value of nuclear medicine studies (CSF shuntograms) and radiographic studies (CT scans) in a cohort of children undergoing evaluation for suspected shunt obstruction in a tertiary care pediatric emergency department. A retrospective chart review was conducted on patients under the age of eighteen years who presented to the Pediatric Emergency Department (ED) of the Children's Hospital of Western Ontario and had both computed tomography (CT) of the head and a CSF shuntogram ordered by the attending pediatric emergency medicine physician between December, 1998 and April, 2003. Nuclear medicine and radiological reports were reviewed for all patients presenting to the ED with suspected shunt obstruction. Three independent investigators interpreted these investigations as normal, inconclusive or abnormal, or inconclusive. Inconclusive investigations were considered to be abnormal in the data analysis. The a priori kappa level of agreement between the three investigators was excellent (kappa=1). A total of 69 patients were evaluated for suspected shunt obstruction during this time period with both CT and CSF shuntogram. Twenty-six (37.7 %) patients subsequently required corrective surgery for suspected shunt obstruction which was confirmed intra-operatively. The CT scans showed abnormalities suggestive of CSF shunt obstruction in 20 of the patients that required surgery (sensitivity, 77%; negative predictive value, 82%) while CSF shuntograms showed abnormalities suggestive of CSF obstruction in 24 of the patients that required surgery (sensitivity, 92%; negative predictive value, 93%). CT scans and shuntograms combined revealed abnormalities suggestive of CSF shunt obstruction in 25 of the 26 patients who required surgery (sensitivity, 96%; negative predictive value, 97%) Over one-third of pediatric ED patients evaluated with CT and CSF shuntograms required surgical management. Both sensitivity and negative predictive values were increased with CT and CSF shuntogram compared to CT alone. Prospective studies are required to assess the use of radiographic and nuclear medicine tests for shunt evaluation in conjunction to the development of a clinical prediction rule for the pediatric emergency physician.
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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 | 0.003 | 0.025 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".