A53 EVALUATING THE DIAGNOSTIC YIELD OF PATIENTS PRESENTING FOR COLONOSCOPY WITH ISOLATED ABDOMINAL PAIN
Bibliographic record
Abstract
Colonoscopy is used as a diagnostic and therapeutic procedure to assess patients with lower gastrointestinal disease. Practice guidelines from the American Society of Gastrointestinal Endoscopy (ASGE) outline accepted indications for colonoscopy; however, there is disagreement over there use in patients who present with abdominal pain in the absence of other symptoms. These guidelines state that colonoscopy is generally not indicated for chronic abdominal pain, noting that there are “unusual exceptions in which colonoscopy may be done once to rule out disease, especially if symptoms are unresponsive to therapy”. The diagnostic yield of colonoscopy for the isolated indication of abdominal pain is thought to be low, though few studies have been published that confirm this. While it is generally considered a safe procedure, colonoscopy carries potentially serious risks including perforation, bleeding, discomfort, and issues related to anxiolysis. Furthermore, colonoscopy is a limited resource with multiple firmly established indications. The aim of our study was perform a quality initiative to assess the diagnostic yield of colonoscopy and procedure related complications for the isolated indication of abdominal pain. We performed a retrospective analysis of all patients undergoing colonoscopy in the Central Zone of Nova Scotia Health Authority for the isolated indication of abdominal pain, from April 1, 2015 to March 30, 2016. Data was retrieved from the Clinical Outcomes Research Initiative (CORI) database, including patient demographics, supplemented by information obtained from regional Horizon Patient Folder. The primary outcome was endoscopic findings, and secondary outcome was procedure related complications. In total, 98 participants received a colonoscopy for isolated abdominal pain. Participants had a mean age of 52 years (range 16–84), of which 63.3% were female. Abnormal colonic findings were identified in 48% of colonoscopy reports, with biopsies taken in 56% of cases. Colonic polyps and diverticulosis were each detected in 24.5% of participants and were the most frequent diagnostic findings. Other findings at time of colonoscopy included hemorrhoid (3.1%), malignancy (1.0%), and Crohn’s disease (1.0%). No immediate complications were reported. Over half of the patients underwent a biopsy during the procedure and approximately 1 in 4 patients were found to have polyps. The diagnoses of Crohn’s disease, malignancy and diverticular disease may account for patients’ abdominal pain; however, these finding represented only 27% of our study population. This quality analysis reveals a low diagnostic yield for significant findings that may be attributable to the patients’ abdominal pain at our center. More research is needed to determine what subgroups of patients with abdominal pain may benefit from colonoscopy. None
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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 | 0.004 | 0.025 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| 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 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".