54 Postoperative emergency department presentations following paediatric G-tube placement
Bibliographic record
Abstract
Abstract Background As children with complex medical needs live longer, adequate nutrition, especially in those with neurological impairments, is increasingly crucial. Gastrostomy tube (G-tube) placement is common in paediatric surgery but often leads to complications, such as tube dislodgement and skin irritation, resulting in high post-operative emergency department (ED) visits. In a U.S. study, 28.9% of children needed unplanned hospital care within 30 days post-G-tube placement. In Canada, paediatric G-tube-related ED visits add to the severe overcrowding, reducing care quality and safety. Objectives The objective of this study was to assess the frequency of ED visits among paediatric patients who underwent operative G-tube placement in Nova Scotia within a 90-day timeframe. Our specific goals included identifying the primary reasons for these presentations and evaluating the prevalence of ED visits that could potentially have been avoided with appropriate care interventions. Design/Methods This study is a retrospective review of all paediatric patients who had a surgically placed G-tube at the IWK between April 1, 2016, and March 31, 2022, and then presented to a Nova Scotia ED within 90 days of their surgery. Chart review was performed after identifying patients using provincial and national databases. Patient demographics, surgical variables, and details from the ED visit (reason for presentation, diagnosis, disposition) were abstracted. Results During the study period, 125 patients underwent surgical g-tube placement and 53.6% (N=67) presented to the ED at least once within 90 days of their surgery. 56.9% of ED visits were for medical reasons unrelated to the primary surgery while 43.1% were surgically related. 63% of patients were discharged home and 30.8% required hospital admissions. Of those admitted, 20% were related to the g-tube surgery. Tube dislodgement was the most common complication, making up 24.6% of ED visits in 90 days. Superficial surgical site infection (SSI) and granulation tissue were the second most common postoperative complications, making up 13.9% of ED visits. Conclusion In Nova Scotia, ED utilization is high in children with gastrostomy tubes, for both medical reasons and those related directly to the operation. Tube dislodgement and superficial SSI were found to be the most common complication. Investigation into possible outpatient resources to manage these common postoperative issues could significantly decrease ED utilization and improve patient care.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| 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".