PD099: Predicting peri-implant disease: chi-squared automatic interaction detection (CHAID) decision tree analysis of risk indicators

Background and aims: Postmenopausal endometrial polyps are commonly managed by surgical resection; however, expectant management may be considered for some women due to the presence of medical co-morbidities, failed hysteroscopies or patient’s preference. This study aimed to identify patient characteristics and ultrasound morphological features of polyps that could aid in the prediction of underlying pre-malignancy or malignancy in postmenopausal polyps. Methods: Women with consecutive postmenopausal polyps diagnosed on ultrasound and removed surgically were recruited between October 2015 to October 2018 prospectively. Polyps were defined on ultrasound as focal lesions with a regular outline, surrounded by normal endometrium. On Doppler examination, there was either a single feeder vessel or no detectable vascularity. Polyps were classified histologically as benign (including hyperplasia without atypia), pre-malignant (atypical hyperplasia), or malignant. A Chi-squared automatic interaction detection (CHAID) decision tree analysis was performed with a range of demographic, clinical, and ultrasound variables as independent, and the presence of pre-malignancy or malignancy in polyps as dependent variables. A 10-fold cross-validation method was used to estimate the model’s misclassification risk. Results: There were 240 women included, 181 of whom presented with postmenopausal bleeding. Their median age was 60 (range of 45–94); 18/240 (7.5%) women were diagnosed with pre-malignant or malignant polyps. In our decision tree model, the polyp mean diameter (≤13 mm or >13 mm) on ultrasound was the most important predictor of pre-malignancy or malignancy. If the tree was allowed to grow, the patient’s body mass index (BMI) and cystic/solid appearance of the polyp classified women further into low-risk (≤5%), intermediate-risk (>5%–≤20%), or high-risk (>20%) groups. Conclusions: Our decision tree model may serve as a guide to counsel women on the benefits and risks of surgery for postmenopausal endometrial polyps. It may also assist clinicians in prioritizing women for surgery according to their risk of malignancy.

Download Full-text

Clinical Prediction Rule for Bacteremia Among Patients with Pyelonephritis and Hospitalization Judgment: Chi-Squared Automatic Interaction Detector (CHAID) Decision Tree Analysis Model

10.21203/rs.3.rs-684788/v1 ◽

2021 ◽

Author(s):

Sayato Fukui ◽

Akihiro Inui ◽

Mizue Saita ◽

Daiki Kobayashi ◽

Toshio Naito

Keyword(s):

High Risk ◽

Blood Culture ◽

Decision Tree ◽

Blood Cell ◽

White Blood Cell ◽

Decision Tree Analysis ◽

Analysis Model ◽

Tree Analysis ◽

Chi Squared ◽

Automatic Interaction Detector

Abstract Background: Positive risk factors for bacteremia among patients with pyelonephritis have not been defined using a Chi-Squared Automatic Interaction Detector (CHAID) Decision Tree Analysis Model. Purpose: We sought to identify predictive factors for bacteremia among patients with pyelonephritis and therefore which patients need hospitalization.Methods: This retrospective cross-sectional survey was performed at the Juntendo University Nerima Hospital, Tokyo, Japan and comprised all patients with pyelonephritis from whom blood cultures were taken from January 1, 2010 to July 31, 2020. At the time of blood culture sample collection, clinical information was obtained from medical charts, along with vital signs, quick Sequential Organ Failure Assessment (qSOFA), subjective symptoms, objective physical findings, laboratory findings, and results of blood and urine cultures. Factors potentially predictive of bacteremia among patients with pyelonephritis were analyzed using the Student’s t-test or chi-squared test and the CHAID decision tree analysis model.Results: A total of 198 patients (male:female, 60 (30.3%):138 (69.7%), ages (mean±SD) 74.69±15.27 years) were included in this study, of whom 92 (46.4%) had positive blood culture results. The CHAID decision tree analysis revealed that patients with White blood cell >21,000/μL had a quite-high-risk (89.5%) of developing bacteremia. Patients with White blood cell ≤21,000/μL plus Chill plus Aspartate aminotransferase >19 IU/L represented a high-risk group (69.0%). Conversely, patients with White blood cell ≤21,000/μL plus non-Chill plus Albumin >3.60 g/dL were at a low risk (16.3%) of developing bacteremia.Conclusion: Our results emphasize the importance of hospitalization among high-risk and quite-high-risk groups of pyelonephritis patients.

Download Full-text