2023 In paediatric trauma patients presenting to a paediatric major trauma centre, does the choosing wisely criteria safely reduce the rate of abdominal CT scanning?
Bibliographic record
Abstract
Aims and Objectives Intra-abdominal injury is found in only 25% of paediatric trauma patients representing a large proportion of patients undergoing unnecessary exposure to ionising radiation and increased cancer risk from CT abdomen scans. Multiple guidelines exist to aid decision-making for CT abdomen requisition in trauma patients. Alder Hey Children’s Hospital use the North West Children’s Major Trauma Network guidelines (NWCMTN) for CT abdomen requisitions in trauma. A level one paediatric trauma centre in Canada developed the Choosing Wisely criteria which resulted in a statistically significant absolute reduction in CT abdomen scanning by 20% with no missed injuries. Aims: Assess adherence to NWCMTN guidelines Quantify patients at very low risk of intra–abdominal injury as per Choosing Wisely to determine whether CT abdomens could be safely reduced Method and Design A retrospective MediTech data search identified 249 CT abdomens performed for patients presenting to the ED at Alder Hey between September 2019 and December 2022 for retrospective comparison against NWCMTN guidelines and the Choosing Wisely criteria. Primary outcomes were the number of CT abdomens performed, CT outcome and the proportion of scans that adhered to NWCMTN guidelines. Results and Conclusion Intra-abdominal injury was found in 20.9% of all scans. 96.4% of CT abdomen requisitions adhered to NWCMTN guidelines. NWCMTN guidelines identified 3.6% of patients with no indications for a CT abdomen. The Choosing Wisely criteria identified 5.2% of patients at very low risk of intra-abdominal injury with no indications for a CT abdomen. Almost all decisions to perform a CT abdomen in paediatric major trauma in the ED at Alder Hey are consistent with the NWCMTN guidelines. CT abdomen scans could be safely reduced by adopting the Choosing Wisely criteria. This audit highlights the importance of maximising guideline adherence and the challenge of identifying patients at very low risk of intra-abdominal injury.
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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 | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 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".