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Surgery or comfort care for neonates with surgical necrotizing enterocolitis: Lessons learned from behavioral artificial intelligence technology

BACKGROUND: Critical decision making in surgical necrotizing enterocolitis (NEC) is highly complex and hard to capture in decision rules due to case-specificity and high mortality risk. In this choice experiment, we aimed to identify the implicit weight of decision factors towards future decision su...

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Autores principales: van Varsseveld, Otis C., ten Broeke, Annebel, Chorus, Caspar G., Heyning, Nicolaas, Kooi, Elisabeth M. W., Hulscher, Jan B. F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10011167/
https://www.ncbi.nlm.nih.gov/pubmed/36925670
http://dx.doi.org/10.3389/fped.2023.1122188
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author van Varsseveld, Otis C.
ten Broeke, Annebel
Chorus, Caspar G.
Heyning, Nicolaas
Kooi, Elisabeth M. W.
Hulscher, Jan B. F.
author_facet van Varsseveld, Otis C.
ten Broeke, Annebel
Chorus, Caspar G.
Heyning, Nicolaas
Kooi, Elisabeth M. W.
Hulscher, Jan B. F.
author_sort van Varsseveld, Otis C.
collection PubMed
description BACKGROUND: Critical decision making in surgical necrotizing enterocolitis (NEC) is highly complex and hard to capture in decision rules due to case-specificity and high mortality risk. In this choice experiment, we aimed to identify the implicit weight of decision factors towards future decision support, and to assess potential differences between specialties or centers. METHODS: Thirty-five hypothetical surgical NEC scenarios with different factor levels were evaluated by neonatal care experts of all Dutch neonatal care centers in an online environment, where a recommendation for surgery or comfort care was requested. We conducted choice analysis by constructing a binary logistic regression model according to behavioral artificial intelligence technology (BAIT). RESULTS: Out of 109 invited neonatal care experts, 62 (57%) participated, including 45 neonatologists, 16 pediatric surgeons and one neonatology physician assistant. Cerebral ultrasound (Relative importance = 20%, OR = 4.06, 95% CI = 3.39–4.86) was the most important factor in the decision surgery versus comfort care in surgical NEC, nationwide and for all specialties and centers. Pediatric surgeons more often recommended surgery compared to neonatologists (62% vs. 57%, p = 0.03). For all centers, cerebral ultrasound, congenital comorbidity, hemodynamics and parental preferences were significant decision factors (p < 0.05). Sex (p = 0.14), growth since birth (p = 0.25), and estimated parental capacities (p = 0.06) had no significance in nationwide nor subgroup analyses. CONCLUSION: We demonstrated how BAIT can analyze the implicit weight of factors in the complex and critical decision for surgery or comfort care for (surgical) NEC. The findings reflect Dutch expertise, but the technique can be expanded internationally. After validation, our choice model/BAIT may function as decision aid.
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spelling pubmed-100111672023-03-15 Surgery or comfort care for neonates with surgical necrotizing enterocolitis: Lessons learned from behavioral artificial intelligence technology van Varsseveld, Otis C. ten Broeke, Annebel Chorus, Caspar G. Heyning, Nicolaas Kooi, Elisabeth M. W. Hulscher, Jan B. F. Front Pediatr Pediatrics BACKGROUND: Critical decision making in surgical necrotizing enterocolitis (NEC) is highly complex and hard to capture in decision rules due to case-specificity and high mortality risk. In this choice experiment, we aimed to identify the implicit weight of decision factors towards future decision support, and to assess potential differences between specialties or centers. METHODS: Thirty-five hypothetical surgical NEC scenarios with different factor levels were evaluated by neonatal care experts of all Dutch neonatal care centers in an online environment, where a recommendation for surgery or comfort care was requested. We conducted choice analysis by constructing a binary logistic regression model according to behavioral artificial intelligence technology (BAIT). RESULTS: Out of 109 invited neonatal care experts, 62 (57%) participated, including 45 neonatologists, 16 pediatric surgeons and one neonatology physician assistant. Cerebral ultrasound (Relative importance = 20%, OR = 4.06, 95% CI = 3.39–4.86) was the most important factor in the decision surgery versus comfort care in surgical NEC, nationwide and for all specialties and centers. Pediatric surgeons more often recommended surgery compared to neonatologists (62% vs. 57%, p = 0.03). For all centers, cerebral ultrasound, congenital comorbidity, hemodynamics and parental preferences were significant decision factors (p < 0.05). Sex (p = 0.14), growth since birth (p = 0.25), and estimated parental capacities (p = 0.06) had no significance in nationwide nor subgroup analyses. CONCLUSION: We demonstrated how BAIT can analyze the implicit weight of factors in the complex and critical decision for surgery or comfort care for (surgical) NEC. The findings reflect Dutch expertise, but the technique can be expanded internationally. After validation, our choice model/BAIT may function as decision aid. Frontiers Media S.A. 2023-02-28 /pmc/articles/PMC10011167/ /pubmed/36925670 http://dx.doi.org/10.3389/fped.2023.1122188 Text en © 2023 van Varsseveld, ten Broeke, Chorus, Heyning, Kooi and Hulscher. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
van Varsseveld, Otis C.
ten Broeke, Annebel
Chorus, Caspar G.
Heyning, Nicolaas
Kooi, Elisabeth M. W.
Hulscher, Jan B. F.
Surgery or comfort care for neonates with surgical necrotizing enterocolitis: Lessons learned from behavioral artificial intelligence technology
title Surgery or comfort care for neonates with surgical necrotizing enterocolitis: Lessons learned from behavioral artificial intelligence technology
title_full Surgery or comfort care for neonates with surgical necrotizing enterocolitis: Lessons learned from behavioral artificial intelligence technology
title_fullStr Surgery or comfort care for neonates with surgical necrotizing enterocolitis: Lessons learned from behavioral artificial intelligence technology
title_full_unstemmed Surgery or comfort care for neonates with surgical necrotizing enterocolitis: Lessons learned from behavioral artificial intelligence technology
title_short Surgery or comfort care for neonates with surgical necrotizing enterocolitis: Lessons learned from behavioral artificial intelligence technology
title_sort surgery or comfort care for neonates with surgical necrotizing enterocolitis: lessons learned from behavioral artificial intelligence technology
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10011167/
https://www.ncbi.nlm.nih.gov/pubmed/36925670
http://dx.doi.org/10.3389/fped.2023.1122188
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