A88 PATIENT-CENTRIC VALIDATION OF A PROVINCE-WIDE COLONOSCOPY REFERRAL SHEET DETERMINING WAIT-TIME PROCEDURAL ALLOCATION
Bibliographic record
Abstract
Abstract Background The widespread use of a standardized, validated province-wide colonoscopy referral form (PCRF), regrouping mutually exclusive indications into suggested priority wait time categories has allowed for a more comprehensive, patient-centric assessment of routine colonoscopy practice Aims To better characterize colonoscopic finding yields based on specific clinical indications (PCRF) determined by patient symptoms’ questionnaire-generated indications rather than referring physician-based indications. We also attempt further validation of the PCRF. Methods Prospective cohort of consecutive adult patients from two hospitals. Information collected from PCRF (therefore referring physician assessment) but also additional symptoms from a patient questionnaire. The primary outcome was the colonoscopy findings. Descriptive and inferential statistics and multivariable regression analyze predictive modeling of different indications and symptoms. Results Overall, 5979 patients (mean age 59.2±14.2years, 49.8% female, mean BMI 26.7±5.2) were included from June 2022 to February 2024. Duration between colonoscopy referral and colonoscopy (days) was 266.7 ± 405.9 (median=138 days). Excluding diverticulosis and non-bleeding hemorrhoids, 41.3% of patients had clinically significant lesions and 0.9% adenocarcinomas. The main indication according to patients was surveillance of polyps (IN13 - 35.7%), surveillance for significant family history (IN21 - 21.2%), IBD surveillance (IN15 - 11.7%). Based on additional questions of the patient questionnaire that did not correspond to any indication on the PCRF, 70.0% had no additional symptoms while 13.3% experienced abdominal pains, and 11.1% cramping, with 4.8% reporting weight loss. Between-group comparisons for adenocarcinoma and clinically significant lesions are described in figure 1. Models with the best fit for predicting adenocarcinoma were associated with the combinations of age>40, and presence of IN2, IN5, IN6 and IN17 with OR=7.74 (4.45; 13.46) (or OR=6.46 (2.78; 15.14) for age>60). Clinically significant lesions were associated with the combinations of age>60, IN5, IN17 and IN13 with OR=2.05 (1.83; 2.90). Conclusions This exercise has allowed further validation of recently adopted provincial changes in PCRF priorities attributed to some indications. Addition of symptoms not captured in PCRF indications did not improve prediction using existing indications in multivariable modelling. The use of multiple PCRF indication in allocating waiting priorities rather than choosing the sole perceived most urgent one (which is how the PCRF is used) now requires prospective validation. Funding Agencies CPAC and MSSS
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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 | 0.008 | 0.020 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".