Get In Line: Queue Position is a Stronger Predictor of Adenoma Detection Than Morning or Afternoon Timing of Colonoscopy
Bibliographic record
Abstract
Purpose: Physician fatigue may adversely affect adenoma detection rate (ADR). Queue position may account for differences in ADR that were previously attributed to the timing of colonoscopy. We aim to determine the role of queue position in the prediction of ADR. Methods: The study was approved by our institution's IRB. We prospectively enrolled patients undergoing outpatient colonoscopy in March and April of 2011. We used the medical record as well as a survey designed for the study to record information about patient demographics, bowel preparation, procedural indications and outcomes. Fisher's exact test and multivariate logistic regression were performed to determine the effects of age, gender, race, bowel preparation (using the validated Ottawa scale), indication for colonoscopy (screening vs. other), total colonoscopy time, timing of colonoscopy (morning vs. afternoon) and queue position (for each endoscopist) on ADR. Results: 125 patients were included in the study (mean age 60.0, 46.4% male). 9.6% were African American, 18.4% were Asian and 60.8% were Caucasian. 87.2% of bowel preps were excellent (total Ottawa score of 4 or less). 42.4% of procedures were done for screening purposes only. The average time for each procedure was 16.4 minutes, the average withdrawal time was 6.3 minutes and the cecal intubation rate was 100%. 67 procedures (53.6%) were performed before 12:00 pm. The average queue position was 3.0 (range 1-7). The overall ADR was 41.6%. In a univariate analysis, the first patient in the queue was more likely to have an adenoma removed than in all the other queue positions combined (56.7% vs. 36.8%, p=0.044, Fisher's exact test). After multivariate logistic regression, the first position in the queue was strongly associated with adenoma detection (p=0.050) while morning (vs. afternoon) colonoscopy was not (p=0.256). Among the other factors included in the multivariate analysis, total procedure time >20 minutes was significantly associated with adenoma detection (p=0.002) and age >65 showed a trend toward significance (p=0.065). Conclusion: In this small prospective study of patients undergoing outpatient colonoscopy, the first position in the queue was associated with a higher adenoma detection rate than all of the other queue positions while there was no difference between morning and afternoon start times. Our findings support recently published evidence that queue position may most accurately reflect physician fatigue during colonoscopy. Larger studies are necessary to further validate these findings.
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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 | 0.007 |
| 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 | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.006 | 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".