Does the incremental shuttle walk test predict the development of a hospital acquired pneumonia in patients undergoing elective oesophagectomy: A service evaluation
Bibliographic record
Abstract
Introduction Post-operative morbidity following oesophagectomy is high, with pulmonary complications, including hospital acquired pneumonia (HAP), the most commonly reported. Functional assessment to determine fitness for surgery is important to provide an individualised risk profile, helping to guide collaborative decision making around selection for surgery and post-operative care. The incremental shuttle walk test (ISWT) can be used to objectively measure functional capacity. Previous studies have demonstrated walking <350m on the ISWT is associated with significantly higher 30 day and 3-year mortality. The aim of this service evaluation was to assess if walking <350m on the ISWT correlated with the development of HAP. Methods Consecutive patients with oesophagogastric cancer listed for an elective oesophagectomy at a large U.K. tertiary hospital between December 2017 and February 2020 were included in analysis. All patients completed the ISWT at pre assessment clinic approximately 1 week prior to surgery. Primary outcome was incidence of HAP. Secondary outcomes included re-intubation rates, intensive care unit (ICU) re-admissions, ICU and hospital length of stay, and 30, 90 day and 12 month mortality. Results 121 patients completed the ISWT and were included in analysis of which 25 (21%) walked <350m. Those walking <350m had significantly higher rates of hospital acquired pneumonia (44% v. 11%, p = 0.0003) and spent significantly longer on ICU (5 v. 3 days, p = 0.041). Poor performance on ISWT had no significant effect on either 30, 90 day or 12 month mortality. Conclusion Walking less than 350 metres on the ISWT pre operatively was associated with a significant increase in the likelihood of developing HAP and longer stays in the ICU. The ISWT may therefore be a useful tool to help manage patient and clinician expectations, guide clinical decision making related to post-operative care, for example, high dependency unit vs ICU and direct post-operative resources like physiotherapy to patients most at risk.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| 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) | 0.001 | 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".