Reliability and Responsiveness of Endoscopic Indices for Assessing Crohn’s Disease Postoperative Recurrence in the PREVENT Trial
Bibliographic record
Abstract
BACKGROUND & AIMS: Assessing endoscopic activity is integral in the management of postoperative Crohn's disease (CD). We aimed to comprehensively characterize the reliability and responsiveness of different endoscopic instruments when used to assess postoperative CD activity. METHODS: Ileocolonoscopy videos (n = 70) from the PREVENT (Prospective, Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial Comparing REMICADE ® [infliximab] and Placebo in the Prevention of Recurrence in Crohn's Disease Patients Undergoing Surgical Resection Who Are at an Increased Risk of Recurrence) trial were reviewed by 3 blinded central readers. Disease activity was assessed using the Rutgeerts and modified Rutgeerts scores, POCER (postoperative Crohn's endoscopic recurrence) index, REMIND (groupe de REcherche sur les Maladies INflammatoires Digestives) score, Simple Endoscopic Score for Crohn's Disease (SES-CD), and the Crohn's Disease Endoscopic Index of Severity (CDEIS). Reliability was quantified by the intraclass correlation coefficient (ICC). Responsiveness was quantified using the win probability (WinP) defined as the probability that a patient in the treatment (infliximab) group had a better score than a patient in the placebo group. The neoterminal ileum, anastomosis, and distal colon were scored separately. RESULTS: Interrater reliability was substantial for the Rutgeerts and modified Rutgeerts scores, ileal REMIND score, SES-CD, and CDEIS (ICC 0.74-0.80), moderate for the POCER index (ICC 0.49), and fair for the anastomotic REMIND score (ICC 0.30). A large degree of responsiveness was observed for the Rutgeerts and modified Rutgeerts scores, ileal REMIND score, SES-CD, and CDEIS (WinP 0.75-0.83). The degree of responsiveness for the POCER index and the anastomotic REMIND score was small (WinP 0.54 and 0.53, respectively). Estimates of index reliability and responsiveness were consistently lower when assessed at the anastomosis or distal colonic segment compared with the neoterminal ileum. CONCLUSIONS: Existing endoscopic indices are reliable and responsive for assessing postoperative CD activity in the neoterminal ileum, although are suboptimal for evaluation in the anastomosis or distal colonic segment.
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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 | 0.040 | 0.091 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 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".