Prediction of Complications and Prognostication in Perioperative Medicine: A Systematic Review and PROBAST Assessment of Machine Learning Tools.

BACKGROUND: The utilization of artificial intelligence and machine learning as diagnostic and predictive tools in perioperative medicine holds great promise. Indeed, many studies have been performed in recent years to explore the potential. The purpose of this systematic review is to assess the current state of machine learning in perioperative medicine, its utility in prediction of complications and prognostication, and limitations related to bias and validation. METHODS: A multidisciplinary team of clinicians and engineers conducted a systematic review using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol. Multiple databases were searched, including Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, PubMed, Medline, Embase, and Web of Science. The systematic review focused on study design, type of machine learning model used, validation techniques applied, and reported model performance on prediction of complications and prognostication. This review further classified outcomes and machine learning applications using an ad hoc classification system. The Prediction model Risk Of Bias Assessment Tool (PROBAST) was used to assess risk of bias and applicability of the studies. RESULTS: A total of 103 studies were identified. The models reported in the literature were primarily based on single-center validations (75%), with only 13% being externally validated across multiple centers. Most of the mortality models demonstrated a limited ability to discriminate and classify effectively. The PROBAST assessment indicated a high risk of systematic errors in predicted outcomes and artificial intelligence or machine learning applications. CONCLUSIONS: The findings indicate that the development of this field is still in its early stages. This systematic review indicates that application of machine learning in perioperative medicine is still at an early stage. While many studies suggest potential utility, several key challenges must be first overcome before their introduction into clinical practice.

[Dangerous practices and games at school]. / Pratiques et jeux dangereux en milieu scolaire.

Dangerous practices and games at school. Three separate categories of dangerous games can be distinguished. The non-oxygenating or fainting games, which consist of mechanical compressions or strangulative mechanisms. These are performed in the search of pseudo-hallucinogenic sensations. There are several such games: from the simple but non-the-less dangerous "tomato game", performed by younger children (from 3-4 years of age), to the "choking game", between 7 and 14 years of age. "Aggressive" or "violent" games which use physical and psychological violence from a group of people towards a single individual. Acute neurological complications can be the consequence of such games, and their degree depends on the duration and intensity of the strangulation. These can vary from cerebral edema, loss of consciousness, long term cerebral damage (deafness, blindness, bedridden), irreversible coma and death. Physical consequences of aggressive games are equally important, such as vertebral fractures, cranial trauma, organ rupture. Victims of violence present repeated psycho-traumatic manifestations. Preventive messages associate information on the risks of such games with civic education (listening, solidarity and trust in others), the development of psychological and social skills, an active involvement in school-life and concrete responsibility taking. Early identification of symptoms of these practices by family members and professionals helps to avoid their repetition and increased danger, even addictive patterns.

Pratiques et jeux dangereux en milieu scolaire. Les pratiques dangereuses en cour d'école sont multiples. Les jeux dits de non-oxygénation ou d'évanouissement consistent, par un mécanisme de compression ou de strangulation, à rechercher certaines sensations pseudo-hallucinatoires. Les jeux dits d'agression ou jeux violents utilisent la violence physique ou psychologique de manière gratuite d'un groupe de jeunes envers une personne seule. Leur caractère répétitif dans le temps définit le harcèlement. La durée et l'intensité de la strangulation peuvent induire des complications neurologiques aiguës (oedème cérébral, perte de connaissance prolongée), des lésions cérébrales définitives (surdité, cécité, état grabataire), un coma irréversible, le décès. Les conséquences physiques des jeux d'agression sont très lourdes : fractures de la colonne vertébrale, traumatismes crâniens, ruptures d'organes. Les enfants victimes ont des manifestations psychotraumatiques répétées. Les messages de prévention associent, outre une information sur les risques, une éducation à la citoyenneté (écoute, cohésion, solidarité, confiance en l'autre), le développement de compétences psychologiques et sociales de l'enfant, une implication active du jeune dans la vie scolaire et la prise de responsabilités concrètes. Le repérage par les familles et les professionnels de symptômes chroniques évocateurs de ces pratiques permet d'éviter leur répétition et leur dangerosité encore accrue, voire un passage à l'addiction.

[The child and his allergenic environment]. / L'enfant allergique et son environnement.

The child and his allergenic environment. Environment's allergens may promote sensitization and after that generate symptoms (allergy). Allergic diseases are frequent in childhood and food allergy increase. Environmental factors may be aeroallergens but also food allergens. The first step of the therapeutic possibilities is to avoid the allergens, with lifestyle modifications. Emergency plan is necessary for school. A first prevention level is feasible and probably useful for food allergy, but not for respiratory allergy.

L'enfant allergique et son environnement. L'environnement avec les allergènes qu'il contient est capable de générer chez l'enfant une sensibilisation. Des symptômes cliniques définissent l'allergie, maladie fréquente surtout en pédiatrie, et très contraignante en cas d'allergie alimentaire. En fonction des allergènes respiratoires, mais aussi alimentaires, des mesures d'éviction sont à proposer pour modifier cet environnement, parfois en changeant le mode de vie. Le projet d'accueil individualisé est indispensable en milieu scolaire. La prévention primaire qui viserait à éviter l'apparition de l'allergie a pu démontrer une certaine efficacité pour l'allergie alimentaire, mais pas pour les allergies respiratoires.