Introduction of the TIDE protocol to screen children for treatable intellectual disability: First evaluation of protocol use by community pediatricians in British Columbia
Bibliographic record
Abstract
Background: The TIDE (Treatable Intellectual Disability Endeavor) Protocol is a two-tiered evidence-based approach used to screen children for treatable genetic conditions (inborn errors of metabolism) causing intellectual disability. A systematic literature review performed in 2012 identified 81 treatable intellectual disabilities. The TIDE first-tier assessment can be used to identify 52 of these 81 conditions using readily available biochemical tests of urine and blood. The TIDE second-tier assessment takes a more targeted approach to identifying the remaining 29 conditions, and includes single metabolite or primary molecular analysis. Because these analyses can be more expensive and require invasive sampling procedures, the secondtier diagnostic workup is handled by hospital-based specialists. Methods: The TIDE Protocol was introduced to 19 BC-based pediatricianspediatricians with the help of a consensusbuilding workshop and downloadable resources (available at http:// tidebc.org/Ph/physicians.html and www.tidebc.org/Ph/Ph/bcmj.html) designed to facilitate the use of the protocol in a community setting: detailed information about the TIDE Protocol, stickers to place on laboratory requisitions, and forms for referral to the Biochemical Diseases Clinic at BC Children’s Hospital. To evaluate knowledge, acceptance, and use of the protocol, participating pediatricians were asked to respond to a web-based survey 18 months after the workshop was held. Results: Of the 19 participating community pediatricians, 13 responded to the survey (68.4%). Respondents demonstrated knowledge of the TIDE first-tier tests and recognized the indications for referral to BC Children’s Hospital. All respondents said that the protocol made a change in their clinical practice.Conclusions: The acceptance of the TIDE Protocol by community pediatricians surveyed suggests there is a solid basis for implementing the protocol throughout BC. Because performing TIDE first-tier tests captures 65% of currently known treatable conditions causing intellectual disability, expanding the use of the protocol could lead to improvements in early diagnosis and treatment of inborn errors of metabolism, and prevention of brain damage.
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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 | 0.230 | 0.233 |
| Meta-epidemiology (narrow) | 0.001 | 0.003 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.007 | 0.003 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.006 | 0.008 |
| Research integrity | 0.003 | 0.005 |
| Insufficient payload (model declined to judge) | 0.012 | 0.003 |
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".