Delayed surgical diagnosis and treatment of severe sickle cell arthropathy: The need to raise clinicians’ awareness
Bibliographic record
Abstract
OBJECTIVES: Sickle cell disease (SCD) is associated with femoral head osteonecrosis and is treated with hip arthroplasty 18 weeks after presentation. However, there is inadequate data regarding the timing of surgical management of severe hip arthropathy. This study explores the problem of delayed diagnosis and surgical management of severe SCD hip arthropathy by comparing the clinical outcomes of patients from Nigeria, Canada and Britain. METHODS: This is a prospective clinical audit of the routine care of 30 adult SCD patients who underwent hip arthroplasty for femoral head osteonecrosis. The clinical data are collected from five medical centers in Britain, Canada and Nigeria and compared. RESULTS: Hip arthroplasty was delayed beyond 18 weeks in 3 of 14 Nigerian patients (21%), 7 of 10 British patients (70%) and all 6 Canadian patients (100%). The majority of Nigerian patients (79%) and only 30% of British patients had diagnostic imaging and surgical management without delay. CONCLUSION: Inadequate physician awareness and delayed surgical management of SCD hip arthropathy can be mitigated by improving the education of physicians who manage patients with SCD. It is essential to recruit, train and support physicians with an interest in SCD. As this primarily affects young patients, it is necessary to set an international standard for the timing of surgical management of SCD hip arthropathy.
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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 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".