Evaluation of bedside sonography performed by emergency physicians to detect intussusception in children in the emergency department
Bibliographic record
Abstract
OBJECTIVE: The aim of our study was to evaluate the test characteristics of point-of-care ultrasound (POCUS) performed by emergency physicians with varying levels of experience among children having undergone diagnostic radiology ultrasound for intussusception in a pediatric emergency department (PED). METHODS: This was a subanalysis of a prospective cohort study conducted at a tertiary care PED. The study population was a sample of children younger than 5 years old who required an abdominal ultrasound for suspected intussusception. Participating physicians had varying levels of POCUS experience. They received a 1-hour didactic and practical training session on intussusception ultrasound. All POCUS was performed following the initial physical examination and prior to further radiologic evaluation. The final outcome was determined by radiologic evaluation performed by a pediatric radiologist. Test characteristics were calculated for POCUS compared with the criterion standard of ultrasound read by a pediatric radiologist. A secondary analysis compared test characteristics of POCUS performed by physicians with different level of POCUS training. RESULTS: A total of 131 children were evaluated by POCUS, of whom 45 (34%) had an intussusception. Twenty-four physicians performed between one and 25 POCUS procedures. POCUS identified 39 of 45 intussusception cases, with a sensitivity of 0.87 (95% confidence interval [CI] = 0.74 to 0.94). A normal or inconclusive POCUS was reported for 83 of the 86 negative studies, with a specificity of 0.97 (95% CI = 0.90 to 0.99). When excluding the 28 patients for whom the physician reported an inconclusive examination, the sensitivity improved to 0.98 (95% CI = 0.97 to 1.00) and the specificity to 0.94 (95% CI = 0.85 to 0.99). The accuracy of diagnosis using POCUS was 42 of 43 (98%) for experienced sonographers in comparison to 81 of 88 (92%) for novices. CONCLUSION: This study demonstrated a very good sensitivity and specificity of POCUS for intussusception in children when performed by multiple emergency physicians with varying POCUS experience.
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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 | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| 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 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".