S12 The changes in incidence and management of pleural empyema in England over the last decade
Bibliographic record
Abstract
Introduction Pleural empyema represents a significant healthcare burden due to extended hospital admissions and/or requirement for surgical intervention. Epidemiological studies from Europe and North America have shown a steady increase in incidence, especially in the elderly.1 2 No epidemiological studies have been performed in England. This study aimed to assess changes in incidence and management of pleural empyema over the last 10 years. Methods Hospital Episode Statistics data was used to identify every patient admitted to an English hospital with pleural empyema (code J86), as well as all previously validated codes for viral influenza and pneumonia. Descriptive statistics were used to represent the change in empyema incidence, management and mortality. Linear regression analysis was used to compare the incidence of empyema with other respiratory infections. Results Between April 2008 and April 2018 there were 53,161 patients admitted with empyema. There was male predominance (67% vs 33%). The incidence of empyema has significantly increased from 4916 in 2008 to 7011 in 2017, see figure. There was seasonal variation with rates in the winter months increasing by a quarter. The median hospital length of stay in adults was 17 days (IQR 8 to 32). The proportion requiring surgery has remained stable (15.2%), but the proportion of open surgery has fallen. Mortality rates remain approximately 12–14% throughout the study period. Incidence correlates closely with rates of viral influenza (r=0.60) and was highest in the children and young adults during the 2010/2011 influenza season. Conclusion This is the first population level assessment of empyema incidence in this country. Rates of empyema admissions have steadily increased with a seasonal variation that may be related to influenza incidence. Results of linkage of the HES data to Public Health England influenza statistics will be presented at the conference. References Finley C, Clifton J, Fitzgerald JM, Yee J. Empyema: an increasing concern in Canada. Can Respir J. 2008;15(2):85–9. Farjah F, Symons RG, Krishnadasan B, Wood DE, Flum DR. Management of pleural space infections: a population-based analysis. J Thorac Cardiovasc Surg. 2007;133(2):346–51.
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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 | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 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".