A prospective evaluation of peri-operative glucocorticoid use in the management of cervicofacial infections of odontogenic origin
Bibliographic record
Abstract
Odontogenic cervicofacial infections requiring inpatient management are treated in a routine manner by oral and maxillofacial surgeons in Manitoba. After a standardized pre-operative workup, patients undergo surgical intervention including extraction of necessary teeth and incision and drainage of associated abscess(es). Patients are treated post-operatively with antibiotics, steroids, and medications for supportive care until appropriate for discharge. Benefits of intravenous corticosteroids in patients undergoing dentoalveolar and maxillofacial surgery include improved comfort, reduced post-operative edema, and shortened time to recovery. Corticosteroids also aid in reducing the risk of morbidity by limiting mass effect from edema and associated airway obstruction. In addition, their anti-inflammatory effect limits further swelling from manipulation of soft tissues during surgical procedures. Current literature supports the use of corticosteroids in the management of primary and deep space neck infections. However, corticosteroid dosing regimens are currently determined by the clinical judgment of the attending surgeon and are not standardized. The purpose of this study was to provide guidance for optimal dosing of methylprednisolone in the management of odontogenic cervicofacial infections. This prospective study followed the inpatient course of 28 patients with various cervicofacial infections of odontogenic origin. All patients were treated with a standardized surgical protocol, antibiotics, and steroids. Patients were randomized to receive one of two methylprednisolone dosing regimens. 14 patients were assigned to receive one dose of methylprednisolone 125mg IV at the time of surgery. The remaining 14 patients received one dose of methylprednisolone 125mg IV at the time of surgery and three consecutive doses of methylprednisolone 125mg IV every six hours post-operatively. Patients were evaluated at the time of hospital presentation and daily throughout admission. Outcomes evaluated included C-reactive protein (CRP) levels, white blood cell (WBC) count, length of hospital admission, and trismus. By examining differences in outcome success variables, the goal of this study was to support future evidence-based dosing decisions in the peri-operative treatment of inpatients in Manitoba. Data analysis showed a greater reduction in CRP throughout admission in the four-dose methylprednisolone group that was statistically significant. No significant difference in daily WBC count or trismus was found.
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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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 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".