The impact of ventilator-associated pneumonia among prehospital intubated patients.
Bibliographic record
Abstract
The objective of this study was to determine if all-cause mortality and hospital length of stay among patients who develop ventilator-associated pneumonia (VAP) differs for patients intubated in the Prehospital setting compared to those intubated in the Emergency Department. A retrospective cohort design was employed and secondary data was retrieved from the local VAP Surveillance database and manual chart reviews. Intubated patients entered the cohort upon VAP diagnosis and exited upon death or hospital discharge. This study used data from three large inner-city adult hospitals within Calgary, Alberta Canada. The sample (n=193) consisted of all adult (>18 years old) patients that developed VAP in an Intensive Care Unit who were intubated either in the Prehospital or Emergency Department setting during the study period (January 01, 2005 and December 31, 2009). Patients in this study intubated in the Prehospital setting were very similar to patients intubated in the Emergency Department with regards to basic demographic and admission characteristics. This study provides several novel results about the association between endotracheal intubation (ETI) location and morbidity and mortality among patients who acquire VAP in the ICU. Patients who suffer severe illness or injury (APACHE II score >25) are more likely to die if they are intubated in the Prehospital setting compared to the Emergency Department (p=<0.001). Furthermore, Prehospital ETI patients who die, do so sooner than Emergency Department ETI patients; whereas Prehospital ETI patients who survive, have longer hospitalizations than their Emergency Department counterparts (p=<0.001). Perhaps preventing ETI in the Prehospital setting or postponing ETI until Emergency Department would result in decreased hospital mortality. Further research is required before this information should be used in a clinical setting.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 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".