Predicting surgery within one week of emergency department presentation for renal colic using the CLAD–MB score: A prospective cohort study
Bibliographic record
Abstract
BACKGROUND: The Complicated UroLithiasis and Alternative Diagnoses (CLAD) score was derived from a retrospective cohort to predict the likelihood of surgery within 7 days following emergency department (ED) presentation for renal colic. The objective of this study was to prospectively refine and validate the CLAD score. METHODS: This was a prospective observational study conducted in five French EDs between July 6, 2021, and July 6, 2023. Patients aged 18 years and older who presented to the ED with renal colic were included. The primary outcome was surgical intervention within 7 days of the ED visit. Logistic regression was used to identify risk factors associated with the need for surgery. RESULTS: Six hundred and two were analyzed including 60 (10 %) that required 7 days surgery. The CLAD - Modified with Biology (CLAD - MB) included: age > 45 years (OR = 1.64; + 1 point), an history of urological surgery (OR = 2.03; + 1 point), a pain score > 7/10 (OR = 2.16; + 1 point), a temperature > 37.8 °C (OR = 4.2; + 2 points), a negative dipstick for blood (OR = 1.53; + 1 point), a CRP ≥ 50 mg/mL (OR = 2.8; + 1 point), a leucocytes count ≥12 G/L (OR = 1.72; + 1 point) and an elevated creatinine (OR = 5.46; + 2 points). A CLAD - MB threshold of <1 had high sensitivity (98 % [91-100]) and low negative likelihood ratio (0.12 [0.02-0.83]). CONCLUSION: CLAD - MB has good prognostic ability for identify patients at low risk of 7-day surgery.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| 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".