Infant malrotation with midgut volvulus: A retrospective review of clinical presentation and delays in care at a Canadian tertiary paediatric centre
Bibliographic record
Abstract
Objectives: Evaluate clinical presentation, delays and outcome in management of children with malrotation with midgut volvulus to identify avenues for care improvement. Methods: A retrospective cross-sectional observational study in a single tertiary care paediatric centre on patients with a final diagnosis of midgut volvulus presenting to the emergency department (ED)/neonatal intensive care unit (NICU) from January 2015 through August 2022. Data recorded included demographics, clinical presentation, imaging, surgical findings, and survival/complications. We recorded time from arrival to hospital to: (1) medical evaluation, (2) radiologic investigations, (3) surgery consultation, and (4) surgery. Outcomes included survival and major morbidity. Results: Thirty children had a diagnosis of midgut volvulus (ED: 22, NICU: 8). Twenty-eight (93%) survived, including two with short bowel syndrome. Median age was 7 days (IQR 3-13), 70% were male. Bilious vomiting was green (13/27; 48%), yellow (9/27; 33%), or both (5/27;19%). All had an ultrasound performed, and it was diagnostic in 24 (80%). Seven (23%) had upper gastrointestinal series performed; all were diagnostic. Median time between arrival and ultrasound was 146 min (IQR 62-234), and between arrival and surgery (Ladd's procedure) was 297 minutes (IQR 206-368). Conclusions: In our cohort, midgut volvulus had a mortality rate of 2/30 (7%). Bilious vomiting, which can be either green and/or yellow, is a reliable clinical sign of midgut volvulus in infants. Ultrasound has good diagnostic accuracy. Delay of definitive surgery was considered high with potential for improvement at different timepoints. These timepoints were targeted in the development of a clinical practice guideline to reduce delays in the management of infants with bilious vomiting.
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.006 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".