Imaging Approach to the Diagnosis of Acute Appendicitis in a Group of Teaching Hospitals with 24/7 In-house Availability of Ultrasound Technologist: Effect of Timing of Request on Imaging Modality
Bibliographic record
Abstract
PURPOSE: The study sought determine effect of requisition timing on the initial-choice imaging modality in appendicitis evaluation. METHODS: This was an institutional review board-approved retrospective study, encompassing 3 University of Toronto teaching hospitals, offering 24/7 radiology coverage. All surgically proven appendicitis cases, from 2012-2014, were included and presurgical ultrasound (US) or computed tomography (CT) reports were analysed. Examinations were all requested by the emergency department, performed by the same technologists and reviewed or finalized by the same radiology group (residents fellows or attending). Two coverage categories, namely regular hours (8 am-5 pm, Monday-Friday) or after hours (5 pm-8 am, Monday-Friday and weekends) were compared. The percentage of the starting modality (US or CT), the rate of CT following an indeterminate US, and the sensitivity of each modality was compared between the 2 categories, utilising Mann-Whitney U and chi-square tests. RESULTS: Presurgical US or CT studies of 494 patients, from February 2012-August 2014, were evaluated. Regular-hours and after-hours coverage demonstrated 174 (89:85 women:men) and 320 (141:179 women:men; P < .04) patients. The average age, 37.9 ± 17.1 women versus 35.2 ± 13.7 men was not statistically different (P = .8). Regular hours included 89 of 174 (51.1%) of US-only examinations, 50 of 174 (29%) of CT-only examinations, and 35 of 174 (20%) of US examinations followed by CT examinations. After hours included 147 of 320 (46%) of US-only examinations, 147 of 320 (46%) of CT-only examinations, and 26 of 320 (8%) of US examinations followed by CT examinations (P < .001). The total diagnostic sensitivities for US and CT were 86% (81% regular hours, 90% after hours; P = .041) and 99.2% (100% regular hours, 99% after hours; P > .05), respectively. CONCLUSIONS: US was less utilised in acute appendicitis detection after hours, although its diagnostic sensitivity was better than regular-hours coverage.
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How this classification was reachedexpand
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 | 0.005 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".