Sensitivity and Specificity of the Brachial Plexus Outcome Measure Activity Scale: A Retrospective Cohort Study
Bibliographic record
Abstract
PURPOSE: Upper limb impairments occur after incomplete recovery from brachial plexus birth injury (BPBI). Reconstructive surgeries are offered to address specific joint-level impairments; however, complete restoration is not possible. Thus, surgical decisions must carefully consider the goal of improving activity function within the child's life context. The Brachial Plexus Outcome Measure (BPOM) Activity scale is an outcome measure of upper limb activity limitation in children with BPBI. It measures the upper limb function on a 5-point ordinal scale, where a score of ≤3 is theoretically an indicator of surgical candidacy; however, no studies have validated this cutoff score. This study aimed to determine whether the BPOM Activity scale score of ≤3 can accurately identify children with BPBI who may benefit from reconstructive surgery. METHODS: A retrospective cohort study was conducted on children with BPBI (4-18 years). Two independent researchers screened the diagnostic, surgical, and outcome data from the health records and a BPBI database. Sensitivity, specificity, and receiver operating characteristic area under the curve (AUC) of ≤3 scores for shoulder, elbow/forearm, and wrist surgeries were used to identify discriminating ability. These analyses were repeated for all scores (≤1 to ≤5) to determine the best cutoff score. RESULTS: Of the 502 patients screened, 251 were included. The sensitivity and specificity of ≤3 scores had acceptable to excellent discriminating ability for shoulder (90%, 72%, 0.81 AUC), elbow/forearm (89%, 90%, 0.89 AUC), and wrist (80%, 93%, 0.86 AUC) surgeries. Sensitivity, specificity, and AUC were the highest at the ≤3 score compared with other cutoff scores. CONCLUSIONS: The BPOM Activity scale ≤3 cutoff score was able to identify children with BPBI who may benefit from upper limb reconstructive surgery. CLINICAL RELEVANCE: These findings indicate that the BPOM Activity scale can help support shared decision-making for interventions to optimize upper limb function after BPBI.
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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 | 0.006 | 0.025 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".