Mind the implementation gap: departure from national guidelines for thromboprophylaxis in traumatic brain injury highlights an urgent need for better evidence
Bibliographic record
Abstract
Patients with traumatic brain injury (TBI) are at high risk of experiencing thromboembolic complications. Therefore, the timely initiation of pharmacologic thromboprophylaxis is imperative. However, fear of provoking expansion of intracranial hemorrhage (ICH) has historically led physicians to delay this decision. Recent studies have shown that thromboprophylaxis within 24–72 hours is feasible without increasing the odds of ICH-related complications. National guidelines offer a framework, typically using the modified Berne-Norwood criteria to stratify by risk of ICH expansion and deferring thromboprophylaxis until repeated head CT is stable.1–3 Despite this current evidence and guidelines, the extent to which practice variation persists has remained unclear.
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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 | 0.149 | 0.404 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.004 | 0.007 |
| Scholarly communication | 0.015 | 0.018 |
| Open science | 0.009 | 0.012 |
| Research integrity | 0.019 | 0.045 |
| Insufficient payload (model declined to judge) | 0.006 | 0.002 |
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".