Clinical Examination for Acute Aortic Dissection: A Systematic Review and Meta‐analysis
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
Abstract Objectives Acute aortic dissection is a life‐threatening condition due to a tear in the aortic wall. It is difficult to diagnose and if missed carries a significant mortality. Methods We conducted a librarian‐assisted systematic review of PubMed, MEDLINE, Embase, and the Cochrane database from 1968 to July 2016. Titles and abstracts were reviewed and data were extracted by two independent reviewers (agreement measured by kappa). Studies were combined if low clinical and statistical heterogeneity (I 2 < 30%). Study quality was assessed using the QUADAS‐2 tool. Bivariate random effects meta analyses using Revman 5 and SAS 9.3 were performed. Results We identified 792 records: 60 were selected for full text review, nine studies with 2,400 participants were included (QUADAS‐2 low risk of bias, κ = 0.89 [for full‐text review]). Prevalence of aortic dissection ranged from 21.9% to 76.1% (mean ± SD = 39.1% ± 17.1%). The clinical findings increasing probability of aortic dissection were 1) neurologic deficit ( n = 3, specificity = 95%, positive likelihood ratio [LR+] = 4.4, 95% confidence interval [CI] = 3.3–5.7, I 2 = 0%) and 2) hypotension ( n = 4, specificity = 95%, LR+ = 2.9 95% CI = 1.8–4.6, I 2 = 42%), and decreasing probability were the absence of a widened mediastinum ( n = 4, sensitivity = 76%‐95%, negative likelihood ratio [LR–] = 0.14–0.60, I 2 = 93%) and an American Heart Association aortic dissection detection (AHA ADD) risk score < 1 ( n = 1, sensitivity = 91%, LR– = 0.22, 95% CI = 0.15–0.33). Conclusions Suspicion for acute aortic dissection should be raised with hypotension, pulse, or neurologic deficit. Conversely, a low AHA ADD score decreases suspicion. Clinical gestalt informed by high‐ and low‐risk features together with an absence of an alternative diagnosis should drive investigation for acute aortic dissection.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.013 | 0.003 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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 it