105 Evaluation of bedside sonography performed by emergency physicians to detect intussusception in children in the emergency department
Bibliographic record
Abstract
Intussusception is difficult to exclude with clinical examination and the final diagnosis is usually made with ultrasound performed by a radiologist. Previous studies suggested that emergency physicians highly experienced in point-of-care Ultrasound (POCUS) have similar performance to formal ultrasound to identify intussusception in children. The aim of our study was to evaluate the ability of emergency physicians with various levels of POCUS experience to detect intussusception with POCUS among children visiting a pediatric emergency department (PED). This was a sub-analysis of a prospective cohort study conducted in a tertiary care PED. The study population was a convenience sample of children younger than 5 years old who necessitated an abdominal ultrasound for suspected intussusception according to the treating physician. Participating physicians were experienced in pediatric emergency medicine but had various levels of POCUS experience. They received a 1-hour didactical and practical training session on intussusception ultrasound. To be included in the sub-study, participants had to be seen by a physician who received the POCUS training. All POCUS were performed by the treating physician before further radiological evaluation following initial physical exam. Final outcome was determined by radiological final evaluation performed by a pediatric radiologist. The primary analysis was a simple proportion for the sensitivity and specificity of POCUS to identify intussusception. During the study period, a total of 238 children were recruited. Among them, 131 were evaluated by POCUS by an emergency physician, of which 45 (34%) had an intussusception. Twenty-four physicians performed between 1 and 25 POCUS for this study. The POCUS identified 39/45 intussusception for a sensitivity of 0.87 (95%CI: 0.74–0.94). A normal or inconclusive POCUS was reported for 83 of the 86 controls for a specificity of 0.97 (95%CI:0.90–0.99). When excluding the 28 patients for whom the physician reported an inconclusive exam, the sensitivity improved to 0.98 (95%CI: 0.97–1.00) and the specificity to 0.94 (95%CI: 0.85–0.99). This study demonstrated an excellent sensitivity and specificity of POCUS for intussusception in children when performed by multiple emergency physicians with variable POCUS experience.
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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 | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".