Search Results (159)

Background: Gastrointestinal (GI) involvement is increasingly recognised in paediatric SARS-CoV-2 infection and multisystem inflammatory syndrome in children (MIS-C), but severe GI bleeding remains rare. Its pathogenesis in this setting is multifactorial: direct viral injury, hyperinflammatory microvascular damage, treatment-related mucosal injury, and coagulopathy may all contribute, and the relative role of each is often difficult to disentangle. Case Presentation: A previously healthy 12-year-old boy underwent appendectomy for perforated appendicitis with peritonitis. On postoperative Day 1, he developed high fever and was found to be SARS-CoV-2 PCR-positive; SARS-CoV-2 IgM and IgG were also positive. He met the positive clinical elements of the CDC 2023 case definition for MIS-C (persistent fever, multisystem involvement—gastrointestinal, hepatic, haematological, and markedly elevated inflammatory markers), although perforated appendicitis with peritonitis is a sufficient alternative explanation and the diagnosis cannot be regarded as secure (see Discussion). Treatment included broad-spectrum antibiotics (meropenem, amikacin, metronidazole), methylprednisolone 2 mg/kg/day, and intravenous immunoglobulin (IVIG) 2 g/kg. On Day 4 in the paediatric intensive care unit (PICU), the patient developed sudden haematemesis with fresh blood through the nasogastric tube and haemodynamic collapse. Coagulation studies revealed prolonged INR (1.6) and reduced prothrombin activity (42%). The patient was stabilised with packed red blood cells, fresh frozen plasma, and intravenous vitamin K. Fibrogastroscopy demonstrated diffuse mucosal bleeding without ulcers or anatomical defects; histology showed mucosal hyperaemia, mixed basal inflammation with intraepithelial lymphocytes, and small erosions. Melena persisted for several days. The child recovered fully and was discharged after 20 days with substantially improved but not fully normalised laboratory values (residual mild anaemia, Hb 110 g/L, and elevated CRP 32.7 mg/L and D-dimer 5.88 mg/L). Conclusions: Severe upper GI bleeding is a rare but life-threatening event in children with severe SARS-CoV-2 infection and MIS-C. In our case, several mechanisms may have acted in combination, although none could be confirmed individually: possible direct viral enterocyte injury via ACE-2 receptors, hyperinflammatory microangiopathy, high-dose corticosteroid-related mucosal injury, possible broad-spectrum antibiotic-associated vitamin K deficiency, and postoperative critical-illness stress. Their relative contributions cannot be determined from a single retrospective case. Bleeding occurred despite continuous PPI prophylaxis, suggesting that PPI cover alone is insufficient when multiple risk factors coexist; the clinical implication is that risk-factor-based (rather than universal) PPI prophylaxis, together with monitoring of vitamin K-dependent coagulation, should be considered in critically ill children receiving high-dose corticosteroids and prolonged broad-spectrum antibiotics. Full article

Background/Objectives: Cleft palate is developmentally and clinically distinct from cleft lip with or without cleft palate. Prenatal ultrasound reliably identifies clefts involving the lip but performs poorly for the secondary palate, whereas early feeding difficulty is concentrated in palatal clefts. These two observations have not previously been quantified within a single cohort. We aimed to determine whether prenatal detectability and neonatal feeding support requirements follow opposite gradients across cleft phenotypes. Methods: We conducted an ambispective study of a nationally ascertained referral-centre cohort of 328 consecutive children with an orofacial cleft and no clinically recognised syndrome, managed at the national referral centre for cleft surgery in Croatia. The cohort comprises children reaching surgical care and is not a population-based birth registry. Documented prenatal ultrasound diagnosis and feeding method during the first weeks of life were abstracted from medical records; cleft phenotype was confirmed by clinical examination. Proportions were compared with chi-square tests and exact binomial confidence intervals, and factors independently associated with each outcome were identified by multivariable logistic regression. Results: Overall prenatal detection was 76/316 (24.1%; 95% CI 19.4–29.2). Detection differed markedly by phenotype: 38.2% for cleft lip only, 34.0% for cleft lip and palate and 2.0% for cleft palate only (p < 0.001). Nasogastric tube feeding was required by 46/325 children (14.2%; 95% CI 10.6–18.4) and followed the opposite gradient: 0.0%, 14.2% and 24.8%, respectively (p < 0.001). Isolated cleft palate showed the strongest independent negative association with prenatal detection (adjusted OR 0.037; 95% CI 0.009–0.154) and was independently associated with tube feeding (adjusted OR 3.07; 95% CI 1.37–6.89). Of children requiring tube feeding, 43/46 (93.5%; 95% CI 82.1–98.6) had not been detected prenatally. Observed detection rose with year of birth in unadjusted analysis (OR 1.095 per year; 95% CI 1.012–1.185; p = 0.023) but was attenuated and no longer significant after adjustment (OR 1.071; 95% CI 0.991–1.157; p = 0.082); the temporal trend is therefore reported descriptively. An initial refer result at newborn hearing screening was markedly more frequent in children with palatal involvement than in those with cleft lip only (2.8%, 31.6% and 25.5% for cleft lip only, cleft lip and palate and cleft palate only; p < 0.001), contrasting cleft lip only with clefts involving the palate rather than following a monotonic gradient. Conclusions: Prenatal detectability and neonatal nasogastric tube use follow opposite gradients across cleft phenotypes. Children with cleft palate only are simultaneously the least likely to be identified before birth and the most likely to require assisted feeding, and almost all tube-fed infants arrive without a prenatal diagnosis. These findings support, as a practice consideration, routine structured neonatal feeding assessment for every newborn with a palatal cleft irrespective of prenatal findings. Full article

Background: Early discharge with home nasogastric (NGT) feeding has been associated with favorable infant outcomes and high parental satisfaction. However, its impact on parental mental health has been insufficiently studied. We aimed to evaluate symptoms of anxiety and depression in mothers and fathers of very preterm infants discharged with or without NGT feeding. Methods: This prospective cohort study was conducted at a German tertiary perinatal center between October 2020 and May 2024. A total of 238 preterm infants with a birth weight ≤ 1500 g and/or a postmenstrual age (PMA) ≤ 32 weeks were included; 131 were discharged with full oral feeding and 107 with NGT feeding. Symptoms of anxiety and depression were assessed in mothers and fathers using the Hospital Anxiety and Depression Scale (HADS-D) at discharge and at three months corrected age (CA). A total of 201 parent–infant dyads were included. HADS-D assessments were completed by 155 mothers and 135 fathers at discharge and by 121 mothers and 119 fathers at three months CA. Results: At discharge, depression and anxiety scores did not differ between parents of infants discharged with and without NGT feeding. At three months CA, mothers of infants discharged on full oral feeding had higher depression and anxiety scores than mothers of infants discharged with NGT feeding (4.95 ± 3.62 vs. 3.18 ± 2.89; p ≤ 0.01 and 6.42 ± 3.85 vs. 4.79 ± 3.72; p = 0.04), and clinically significant depression scores (≥8) were more frequent (23.53% vs. 10.45%; p = 0.04). Similarly, fathers in the non-tube-feeding group had higher depression scores at 3 months CA (4.78 ± 3.74 vs. 3.48 ± 2.72; p = 0.04), with a trend towards a greater proportion showing clinically significant depression scores (24.14% vs. 13.11%; p = 0.12. Conclusions: Early discharge of very preterm infants with home NGT feeding was not associated with increased parental psychological distress at discharge and at 3 months CA. Across the outcomes, parental distress tended to be lower at 3 months CA with NGT feeding at discharge. However, as no NGT × time interaction was statistically significant after correction for multiple testing, these group differences should be interpreted as exploratory in nature. Full article

Background/Objective: Avoidant/Restrictive Food Intake Disorder (ARFID) is increasingly recognized among hospitalized pediatric patients with malnutrition; however, optimal nutritional management strategies remain poorly defined. Many programs utilize protocols developed for anorexia nervosa (AN). This study examined patterns of nasogastric tube (NGT) use and weight trajectories in pediatric patients with ARFID and AN/atypical AN (AAN) treated under the same inpatient refeeding protocol. Methods: We conducted a retrospective study of pediatric patients admitted for medical stabilization of malnutrition at a tertiary care children’s hospital (n = 160; ARFID subgroup n = 34). Data included NGT utilization and weight change during hospitalization. Longitudinal change in BMI z-scores during hospitalization was modeled using multivariable analysis. Results: Patients with ARFID were more likely to require NGT than those with AN/AAN (p < 0.001), despite similar BMI z-scores at admission and discharge. Patients with ARFID requiring NGT were younger and had lower BMI z-scores at admission than ARFID patients without NGT (p < 0.05). Conclusions: In this study, pediatric patients with ARFID undergoing inpatient nutrition rehabilitation achieved comparable weight gain during hospitalization to patients with AN/AAN but required higher enteral nutrition support to do so. Among patients with ARFID who required NGT support, anthropometric measures suggested higher baseline nutritional severity and likely confounding by indication. Because NGT use was determined clinically rather than randomly assigned, the observed association between NGT use and higher weight gain should not be interpreted as evidence of a causal treatment effect. Interpretation is also limited by variability in clinical practice and the relatively small ARFID subgroup. This study supports diagnosis-specific considerations during medical stabilization and underscores the need for further ARFID-specific protocols and research. Full article

Introduction: Posterior cervical fusion is commonly performed for cervical spine instability and fractures. However, dural injury may result in cerebrospinal fluid leakage, pseudomeningocele, and, rarely, hydrocephalus. These complications may lead to substantial neurological deterioration and functional decline. We report a rare case of severe cognitive impairment and dysphagia caused by postoperative CSF leakage-associated hydrocephalus after C1–2 fusion and highlight the role of comprehensive rehabilitation in functional recovery. Case presentation: A 67-year-old woman sustained a type III odontoid fracture and was initially managed with halo-vest immobilization. Because of fracture nonunion, posterior C1–2 fusion was performed. One month after surgery, she developed progressive mental status deterioration, confusion, and severe functional impairment. Brain computed tomography revealed progressive hydrocephalus, and cervical spine magnetic resonance imaging demonstrated a large posterior fluid collection consistent with pseudomeningocele. Revision surgery and ventriculoperitoneal shunt placement were performed. However, the patient remained bedridden with persistent vomiting, severe cognitive impairment, dysphagia requiring nasogastric tube feeding, and generalized deconditioning. Three months after revision surgery, her neurological condition stabilized and rehabilitation was initiated. Intensive and individualized rehabilitation, including cognitive rehabilitation, swallowing therapy was implemented. After three months of rehabilitation, the patient demonstrated gradual improvement in cognitive function, swallowing function, and mobility, ultimately achieving independent standing and ambulation using a walker. Conclusions: Postoperative CSF leakage-associated hydrocephalus and pseudomeningocele may lead to severe cognitive, swallowing, and functional impairments beyond structural complications alone. Comprehensive, individualized rehabilitation should be considered an essential component of care to maximize neurological and functional recovery. Full article

Background: Heller myotomy (HM) is the standard surgical treatment for achalasia. Complete muscular division while preserving mucosal integrity is essential for optimal outcomes. Indocyanine green fluorescence (ICG) imaging has recently emerged as a potential intraoperative adjunct during minimally invasive HM, although evidence remains limited and heterogeneous. Methods: A scoping review was conducted according to PRISMA-ScR recommendations. PubMed, Scopus, and Web of Science were systematically searched to identify clinical studies reporting intraoperative ICG use during laparoscopic or robotic HM. Data regarding surgical approach, fluorescence technique, intraoperative applications, and outcomes were extracted and descriptively synthesized. Results: Four clinical studies published between 2022 and 2024 were included, involving 58 patients overall, of whom 41 underwent minimally invasive HM with intraoperative ICG fluorescence assessment. Two main fluorescence strategies were identified. Intravenous ICG administration was exclusively evaluated during robotic Heller myotomy, whereas all laparoscopic studies employed intraluminal ICG instillation through a nasogastric tube. Fluorescence imaging was used to assess myotomy completeness, identify residual muscle fibers, and detect mucosal perforation. Intraluminal ICG enabled direct visualization of the mucosal tube and facilitated leak detection, whereas intravenous administration enhanced tissue contrast and identification of residual muscular bundles. No ICG-related adverse events were reported. However, the available evidence was limited to small observational series with heterogeneous protocols and inconsistent outcome reporting. Conclusions: ICG fluorescence appears technically feasible during minimally invasive HM and may support intraoperative assessment of myotomy completeness and mucosal integrity. Although early clinical experience is encouraging, the available evidence remains insufficient to support routine implementation of ICG-guided assessment during Heller myotomy, highlighting the need for standardized prospective comparative studies. Full article

Acute parastomal hernia containing the stomach with subsequent mechanical gastric outlet obstruction is an exceedingly rare phenomenon given the anatomical fixation of the stomach. Herein, we present the case of an 81-year-old female with a history of a Hartmann’s procedure who developed acute vomiting. She was found to have herniation of the stomach into the parastomal hernia sac with tight angulation of the gastroduodenal junction and, therefore, gastric outlet obstruction. Following decompression with a nasogastric tube, we report an open approach with circumstomal mesh for acute emergent repair. Full article

Background: Nimodipine is routinely used in aneurysmal subarachnoid hemorrhage (aSAH), but the optimal route of administration remains uncertain. Intravenous and enteral delivery differ in pharmacokinetics, yet the clinical relevance of these differences is unclear. This scoping review aimed to map evidence on the pharmacokinetics (PK) and pharmacodynamics (PD) of intravenous and enteral nimodipine and their relationship with clinical outcomes. Methods: A scoping review was conducted following PRISMA-ScR guidelines. PubMed, Scopus, and Web of Science were searched from 1982 to March 2026. Studies in adult aSAH patients reporting PK and/or PD outcomes after intravenous or enteral nimodipine were included. Data were synthesized qualitatively. Results: Twenty studies were included. Intravenous administration provided higher and more consistent systemic exposure, whereas enteral administration showed low and highly variable bioavailability, particularly via nasogastric tubes. Despite these differences, pharmacodynamic effects were not clearly related to systemic concentrations, and hypotension occurred similarly across routes. Evidence on cerebral physiology was limited. Randomized studies showed no significant differences in delayed cerebral ischemia, infarction, or functional outcomes between routes. Conclusions: Pharmacokinetic advantages of intravenous nimodipine do not consistently translate into pharmacodynamic or clinical benefits, although available evidence is limited and heterogeneous. The PK–PD relationship appears weak, and further research is needed to guide optimized administration strategies. Full article

Background: Stroke-associated pneumonia (SAP) is a common complication after acute ischemic stroke and contributes to worse recovery and greater resource use. Nutritional and inflammatory dysregulation have been implicated in both SAP susceptibility and adverse prognosis. Objective: To examine whether admission inflammatory and nutritional markers are associated with the development of SAP and with short-term functional prognosis. Methods: We performed a retrospective single-centre cohort study of consecutive patients with acute ischemic stroke admitted between 1 January 2015 and 31 December 2024 ($N=303;SAPn=108,non-SAPn=195$). Admission laboratory indices (albumin, CRP, fibrinogen, WBC, PCT, and prealbumin) in the first 24 h and clinical variables were analysed. Multivariable logistic regression identified factors independently associated with SAP; the relationship between SAP and early functional recovery was assessed in adjusted outcome models. A nomogram integrating key predictors was developed and its apparent discrimination is reported. Results: SAP occurred in 35.6% of patients. Factors independently associated with SAP included nasogastric tube placement (OR: 7.02, 95% CI: 3.50–14.62), venous thromboembolism (OR: 3.20, 95% CI: 1.62–6.31), cognitive impairment (OR: 2.90, 95% CI: 1.32–6.36), and elevated inflammatory markers (WBC OR: 1.52, 95% CI: 1.28–1.80; fibrinogen OR: 1.37, 95% CI: 1.02–1.84; CRP OR: 1.01, 95% CI: 1.00–1.03). Higher admission serum albumin was associated with lower odds of SAP (OR: 0.92, 95% CI: 0.86–0.98). The nomogram showed strong apparent discrimination (AUC: 0.90, 95% CI: 0.86–0.94). After multivariable adjustment, SAP remained associated with poorer short-term functional improvement (adjusted OR: 6.99, 95% CI: 3.05–17.54) and greater healthcare utilization (median length of stay: 39.6 vs. 30.6 days; median cost: USD 12,836 vs. 6585). Conclusion: In this retrospective cohort, admission markers of nutritional depletion and inflammatory activation were associated not only with increased likelihood of SAP, but also with adverse early functional outcomes. These association-based findings support early risk stratification using routine admission markers; prospective studies and external validation are required before clinical implementation. Full article

Objectives: This scoping review synthesized the available evidence on bedside ultrasonography used to confirm short-term nasogastric tube (NGT) placement in adults. Methods: The review followed JBI Collaboration methodology. Searches were conducted in CINAHL, Embase, LILACS, PubMed, and Scopus, as well as in gray literature sources (Google Scholar and ProQuest Dissertation & Thesis Global). Primary studies and clinical guidelines addressing bedside ultrasonography for short-term NGT placement in adults (≥18 years) were eligible, with no limits on language or publication year. Data were extracted and narratively summarized with the I-AIM framework (Indication, Acquisition, Interpretation, and Decision-Making). Results: Twenty-nine studies met the inclusion criteria. Most were single-center observational studies performed in intensive care units or emergency departments. Ultrasound was primarily used for confirmation prior to enteral nutrition initiation, while gastric decompression was less frequently reported. Acquisition protocols varied, although supine positioning, convex abdominal probes, and linear cervical probes were most commonly described. The gastric antrum and esophagus were the principal anatomical landmarks, with interpretation based on direct tube visualization and dynamic fogging; color Doppler was occasionally used. Radiography remained the reference standard in most studies, and only a minority initiated feeding based solely on ultrasound findings. Reported facilitators included bedside feasibility, absence of radiation exposure, and timeliness. Barriers included operator dependency, limited visualization in patients with obesity or gas interposition, protocol heterogeneity, and the limited methodological robustness of available studies. Conclusions: Current evidence suggests that ultrasonography may represent a feasible, radiation-free bedside approach for confirmation of NGT placement. Evidence from selected studies suggests that, with structured training, healthcare professionals may achieve diagnostic accuracy in specific clinical settings, although further robust multicenter investigations are needed to confirm these findings. Full article

Introduction: Eating Disorders (ED) represent a significant health concern in the pediatric population due to high morbidity, prolonged hospital stays, and frequent readmissions. Scientific evidence regarding nutritional factors that may influence length of stay or risk of readmission is limited in this population. Objectives: To identify variables associated with longer hospital stays and readmission in pediatric patients with ED admitted to a reference unit in northern Spain. Methods: A retrospective observational study was conducted following STROBE guidelines, including patients under 18 years admitted for ED at a tertiary referral hospital between 2022 and 2025. Nutritional, anthropometric, clinical, evolution-related, and treatment variables were collected. Descriptive analyses, group comparisons according to length of stay and readmission, and logistic regression models were performed to identify associated factors. Results: The study included 75 patients, predominantly female (94.7%), with a mean age of 14.5 years. Twenty-eight percent of patients experienced at least one readmission during the study period. Multivariable regression identified that the use of a nasogastric tube and nutritional supplements was significantly associated with reduced length of stay. In addition, in patients with moderate to severe malnutrition, a recovery greater than 5% according to the Waterlow index was associated with a lower probability of readmission. Although anthropometric differences were observed between groups according to their need for readmission, most were not statistically significant. Conclusions: Nutritional support via nasogastric tube when indicated, the use of nutritional supplements, and a >5% recovery in the Waterlow index in patients with moderate to severe malnutrition are key factors in reducing hospital stay and readmission risk in pediatric patients with ED in our cohort. Isolated laboratory analyses and anthropometric measures showed limited predictive value in this context. Full article

Background and Clinical Significance: Withdrawal symptoms from an abrupt discontinuation or rapid dose reduction in amantadine has been documented as early as 1987. Symptoms can align with several diagnoses, including but not limited to infection, fever, worsening of Parkinson’s disease, seizures, and an altered mental status. In the case described, the timely diagnosis of amantadine withdrawal was delayed due to its nonspecific presentation. Case Presentation: A man in his 60s presented with lethargy, confusion, and delayed responses. His past medical history included parkinsonism, a seizure, type 2 diabetes, and schizoaffective disorder. Outpatient medications included amantadine, benztropine, divalproex, levetiracetam, paliperidone, risperidone, and semaglutide. He was admitted for an altered mental status, and home medications were held when he became NPO. A nasogastric tube was placed, and amantadine was restarted. Following the amantadine reinitiation, the patient returned to baseline and, after ruling out other causes, was diagnosed with amantadine withdrawal. He ultimately completed a 20-day admission and was discharged to a nursing home. Conclusions: The timely diagnosis of amantadine withdrawal was delayed due to its nonspecific presentation. For patients taking amantadine, clinicians should include amantadine withdrawal in their list of differential diagnoses, and in cases of altered mentation, a careful review of the medication list is essential. Full article

Background: Anorexia nervosa (AN) may require nasogastric tube (NGT) feeding when oral intake is insufficient. Evidence on the psychological impact and prognostic correlates of NGT use in adolescents affected with AN is limited. Methods: Fifty-seven adolescent inpatients (96.5% female; age range 12–18 years; and mean age 15.0 ± 1.51 years) affected with AN admitted in a child psychiatry ward and treated with NGT re-feeding in addition to oral nutrition were included in the study. A 21-item VAS questionnaire was administered at intake (T0), after NGT introduction (T1), after one week of NGT use (T2), and after NGT dismissal (T3) to assess the physical and psychological effects. Participants were also assessed with psychometric measures including personality (TCI), eating psychopathology (EDI-2), general psychopathology (BDI-II, SCL-90-R, and TAS), and family functioning (FAD). The measures were compared between each timepoint with paired t-tests and ANOVA for repeated measures. Pearson correlations were performed between the VAS scores and psychometric measures. Results: From admission to discharge, weight increased by +3.2 kg and BMI by +1.2 kg/m². Items 1, 3, 4, 6, 15, 18, and 20 of the VAS questionnaire items showed significant improvement over time. TCI personality traits, EDI-2 eating and BDI, SCL-90 and TAS general psychopathology, and FAD family functioning were related to NGT perception by the AN adolescents. Conclusions: NGT was helpful in weight progression during inpatient treatment. It was generally well tolerated, with progressive improvement in psychological and physical discomfort during treatment. The meaningful associations with specific psychometric features suggest the possibility to tailor the NGT use based on adolescent characteristics. Multidisciplinary care and tailored psychoeducation may enhance NGT acceptance. Full article

The study’s aim was to compare the unplanned admission rates and nutrition outcomes in patients with head and neck squamous cell cancer (HNSCC) receiving chemoradiotherapy at two different hospitals with different nutrition support approaches. Hospital Site A used prophylactic tube feeding and Site B used reactive tube feeding. Consecutive HNSCC patients receiving chemoradiotherapy with curative intent over six months in 2015 were eligible for this prospective comparative cohort study. Only patients who were classified as at high nutrition risk using validated guidelines were included. Patients’ weight was recorded at the start, end, and 4–6 weeks post treatment to determine percentage weight loss outcomes. Unplanned hospital admissions (for medical or nutrition related reasons) and associated length of stay (LOS) were collected throughout and up to 1-month post treatment. In total, 88 patients were included in the study (site A n = 58; site B n = 30). The mean age was 60 years, 86–90% were male, and predominantly had oropharyngeal cancer. There was no statistical difference between the groups for percentage weight loss at any timepoint, rates of unplanned nutrition related admissions, or LOS. Stepwise logistic analysis showed that being of an older age was predictive of having an unplanned nutrition-related admission. In summary, there was no difference in the rate of unplanned admissions or percentage weight loss for patients with HNSCC managed under the prophylactic versus reactive tube feeding approach. Decision making regarding the choice of feeding tube should be made in consultation with the patient and the multidisciplinary team. Full article

Background: Accurate confirmation of nasogastric (NG) tubes is essential for patient safety, but delays and variability in interpretation remain common in clinical practice. Deep learning (DL) models have shown potential for assisting in this task, but real-world performance, particularly in detecting malpositioned tubes, remains insufficiently characterized. Methods: We conducted a pilot evaluation of a previously developed DL model using 135 chest radiographs from Kangwon National University Hospital. Expert physicians established the reference standard. Model performance was assessed and receiver operating characteristic (ROC) curve and precision recall curve (PRC) analyses were performed. Differences between correctly classified and misclassified cases were examined using Wilcoxon rank-sum and Fisher’s exact tests to explore potential clinical or radiographic contributors to model failure. Results: The model correctly classified 129 of 135 cases. The sensitivity was 96.1% (95% confidence interval (CI): 92.2–98.9%), specificity was 85.7% (95% CI: 42.2–97.7%), positive predictive value (PPV) was 99.2% (95% CI: 96.1–99.9%), negative predictive value (NPV) was 54.5% (95% CI: 25.4–80.8%), balanced accuracy was 90.8%, and F1-score was 0.976. The area under the ROC curve was 0.970 (95% CI: 0.929–1.000) and that under the PRC was 0.727 (95% CI: 0.289–1.000), reflecting substantial uncertainty related to the very small number of incomplete cases (n = 6). No statistically significant differences in clinical or radiographic characteristics were observed between correctly classified and misclassified cases. Conclusions: The DL model performed well in identifying correctly positioned NG tubes but demonstrated limited and unstable performance for detecting incomplete placements. Given the safety implications of misclassification, the model should be used only as an assistive tool with mandatory physician oversight. Larger, multi-center studies with greater representation of incomplete cases are required to obtain more reliable estimates and support safe clinical implementation. Full article