Evaluating the Appropriateness, Consistency, and Readability of ChatGPT in Critical Care Recommendations.

Background: We assessed 2 versions of the large language model (LLM) ChatGPT-versions 3.5 and 4.0-in generating appropriate, consistent, and readable recommendations on core critical care topics. Research Question: How do successive large language models compare in terms of generating appropriate, consistent, and readable recommendations on core critical care topics? Design and Methods: A set of 50 LLM-generated responses to clinical questions were evaluated by 2 independent intensivists based on a 5-point Likert scale for appropriateness, consistency, and readability. Results: ChatGPT 4.0 showed significantly higher median appropriateness scores compared to ChatGPT 3.5 (4.0 vs 3.0, P < .001). However, there was no significant difference in consistency between the 2 versions (40% vs 28%, P = 0.291). Readability, assessed by the Flesch-Kincaid Grade Level, was also not significantly different between the 2 models (14.3 vs 14.4, P = 0.93). Interpretation: Both models produced "hallucinations"-misinformation delivered with high confidence-which highlights the risk of relying on these tools without domain expertise. Despite potential for clinical application, both models lacked consistency producing different results when asked the same question multiple times. The study underscores the need for clinicians to understand the strengths and limitations of LLMs for safe and effective implementation in critical care settings. Registration: https://osf.io/8chj7/.

Resuscitative transesophageal echocardiography during the acute resuscitation of trauma: A retrospective observational study.

BACKGROUND: Resuscitative transesophageal echocardiography (TEE) is an emerging POCUS modality that can be used to guide trauma resuscitation. METHODS: Trauma patients who underwent TEE within 24 h of admission from 2013 to 2022 were prospectively identified. We retrospectively analyzed resuscitative TEE reports and patient charts in duplicate. RESULTS: 29 providers performed TEE for 54 acute trauma patients. 28 (52%) died in hospital; 33 (61%) required operative intervention (<24 h). Median injury severity score was 29 [IQR 22-43]. The most common indications for TEE were hemodynamic instability (34, 63%), inadequate windows for transthoracic echocardiography (14, 26%) and cardiac arrest (11, 20%). There were no identified complications. A new diagnosis was made in 31 (57%) cases: most commonly right ventricular dysfunction (10, 19%), pericardial effusion (9, 17%), and hypovolemia (6, 11%). TEE ruled out major cardiac injury in 83% of cases. TEE changed resuscitative strategy, in 17 (32%) patients, diagnostic imaging approach in 6 (11%) patients, procedural or operative approach in 5 (9%) patients and disposition from the trauma bay in 4 (7%) patients. CONCLUSION: Resuscitative TEE during acute trauma care has an additional diagnostic yield to existing diagnostic pathways and may impact definitive management for some patients in the trauma bay.

Near 5-year survival in metastatic pancreatic cancer patient with ROS1 rearrangement, HER2 amplification, and KRAS G12C mutation-a case report.

Background: Pancreatic cancer is a significant cause of cancer-related deaths in Canada. Although it is less common than other cancers, the mortality rate has remained high and stable since 1984, with a five-year net survival rate being the lowest of 23 reported cancers. The limited options for detection and treatment contribute to the high mortality rate. A developing area of treatment is tumour site agnostic targeted therapy, where patients' cancer is treated based on genomic alterations that are amenable to targeted agents, regardless of where the tumour originated. Case Description: A 52-year-old man with no prior medical history presented with anemia, intermittent fatigue, post-prandial indigestion, and bloating, and 8-10 lbs of unintentional weight loss over a 1-year period. A computed tomography scan of the abdomen revealed pancreatic ductal adenocarcinoma and diffuse liver metastasis. He received multiple local and non-targeted systemic therapies. Serial genomic analyses sequentially revealed c-ros oncogene 1 (ROS1) receptor tyrosine kinase rearrangement, human epidermal growth factor receptor 2 (HER2) amplification, and Kirsten rat sarcoma virus (KRAS) G12C mutation throughout his journey, none of which were present at diagnosis. Each new genomic alteration prompted treatment change. Concurrent with systemic therapy, the patient also received numerous local treatments, including hepatic transarterial chemoembolization, Yttrium 90, Whipple procedure, stereotactic body radiation therapy, and CyberKnife. Over the course of the disease, metastases were found in the lungs, brain, and kidneys. Despite this, the patient had periods of remarkable response and quality of life evidenced by his cycling tour of France. However, nearly five years from diagnosis, the patient elected to pursue supportive care and died from his cancer. Conclusions: This case report demonstrates the importance of repeat genomic analyses in the treatment of advanced cancer and timely access to targeted therapy. The clinical impact of utilizing a tumor-agnostic treatment approach based on these genomic alterations has the potential to yield a strong response both in survival and quality of life.

Completeness of reporting in systematic reviews and meta-analyses in vascular surgery.

OBJECTIVE: Systematic reviews (SRs) and meta-analyses are essential in informing clinical guidelines and decision-making. Complete reporting of SRs through compliance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines promotes transparency, reproducibility, and consistency across the literature. The purpose of this meta-epidemiological study is to assess the completeness of reporting of SRs in the vascular surgery literature. METHODS: MEDLINE and Embase were used to search through four major vascular surgery journals and four high impact general medical journals for SRs published between 2018 and October 2022 evaluating clinical treatments for any pathology treated by a vascular surgeon. Data screening and extraction were conducted in duplicate. The reporting completeness of each included SR was measured with reference to the 27-item PRISMA checklist, and methodological quality was evaluated using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) tool. Parametric tests were used to evaluate for associations between PRISMA score and study funding, protocol registration, publication in a higher impact factor journal, and AMSTAR 2 score. The protocol is available online: 10.17605/OSF.IO/VBC5N. RESULTS: Of 1653 articles captured in the initial search, 162 SRs were included in the final analysis. All SRs had more than one incomplete PRISMA item. The mean PRISMA score was 21.2/27 (standard deviation: 2.9, 78.5% compliance), and the mean AMSTAR 2 score was 11.7/16 (standard deviation: 1.9, 73%). SRs that had a prospectively registered protocol had a higher PRISMA score (22.9 vs 20.6, P < .001) as did those that were published in higher impact factor journals (23.3 vs 21.0, P = .017). There was a large positive correlation between an SR's PRISMA and AMSTAR 2 scores (Pearson r = 0.655, 95% confidence interval: 0.55-0.74). There were no associations between the PRISMA score and publication year (P = .067) or funding status (P = .076). CONCLUSIONS: Overall, the reporting of SRs and meta-analyses in vascular surgery is less than ideal, with several key items being consistently under-reported. Prospective registration and methodological quality as measured by AMSTAR 2 scores are positively associated with improved reporting. Authors, reviewers, and journal editors should consider these findings moving forward to encourage completeness of SR reporting. Raising awareness surrounding the value of complete reporting of SRs can aid in enhancing the quality of evidence, and journals should consider these findings in methods used to promote SR reporting.