An open and shut case for early VATS treatment of primary spontaneous pneumothorax in children.
Bibliographic record
Abstract
BACKGROUND: Treatment of primary spontaneous pneumothorax (SP) involves thoracostomy tube (TT) drainage, with surgery reserved for persistent or recurrent air leaks. We hypothesized that the advent of video-assisted thoracic surgery (VATS) would change indications and outcomes for surgical treatment of SP in our centre. METHODS: We performed a retrospective (1993-2003) review of children treated for SP. Patients with persistent or recurrent air leaks underwent either limited axillary thoracotomy (LAT), 1993-2001, or VATS, 2001-2003. We included the following outcomes: preoperative SP episodes, TT days (that is, patient days with TT in situ, before surgery), length of hospital stay (LOS), narcotic use and freedom from recurrence. We evaluated the predictive value of preoperative CT scans in guiding treatment of the contralateral side. RESULTS: Among 31 patients with 19 ipsilateral or contralateral recurrences (61%), 11 were managed nonoperatively. Twenty-six surgeries (13 LAT, 13 VATS) were performed in 20 patients, with 9 undergoing bilateral procedures (3 LAT, 6 VATS). VATS patients were treated earlier, had a diminished narcotic requirement postoperatively and had a shorter LOS with an equivalent recurrence rate, compared with LAT patients. The absence of contralateral blebs did not predict freedom from SP on the contralateral side in patients undergoing surgery for ipsilateral SP. CONCLUSIONS: Compared with LAT, VATS causes less pain, has a shorter LOS and encourages earlier surgical treatment (including prophylactic, contralateral treatment) of SP in children.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| 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".