Bibliographic record
Abstract
Introduction: Gross hematuria (GH) is a common presenting complaint to the emergency department (ED).Some patients develop hematuria that is severe enough to warrant admission, continuous bladder irrigation (CBI), blood transfusions, and operative interventions.This study aimed to describe the demographics and risk factors of patients that require admission to the hospital for urologic care and develop a novel scoring system to guide clinical decisions.Methods: All patients who presented to the ED with GH at a single institution between 2018 and 2022 were reviewed.Patient demographics, comorbidities, relevant urologic history, and outcomes were recorded.Descriptive statistics were performed.A split-sample based method was employed, with a derivation and validation cohort reviewed separately.Univariate and multivariate analysis (MVA) were conducted to identify variables correlating with the need for admission.Using the Johnson's scoring method, variables that correlated on the MVA were used to develop the scoring system that was then validated on another cohort of patients presenting with GH.Results: Of 1012 patients included in the final analysis of the derivation group, 229 (23%) were admitted.Heart rate >100 beats/minute at presentation, need for CBI, history of urologic malignancy, urologic consultation requested, and need for blood transfusions of ≥2 units were variables found to be predictive of need for admission when developing the scoring system.The scoring system had an area under the curve (AUC) of 0.917 on the receiver operator curve (ROC).By selecting a cutoff score of ≥10 points, a sensitivity of 84% and a specificity of 86% were achieved.This scoring system was validated on a separate validation cohort of 311 patients.The analysis yielded a similar sensitivity and specificity, with AUC of 0.936 on the ROC.Conclusions: We present a novel, practical, and internally validated scoring system to predict patients at risk of requiring hospital admission for GH presenting to the ED.Our proposed scoring system may be helpful in triaging patients and planning hospital bed management.Prospective external validation of this scoring system at both academic and community hospitals is warranted.
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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 | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.275 | 0.177 |
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".