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背景低风险踝部规则是一种关于有效临床决策方法的规则,该规则使得安全减少儿童急性踝部损伤X线检查频率成为可能。研究者对低风险踝部规则的阶段性施用情况及其对减少儿童踝部损伤X线检查频率的作用进行了评估。方法 2009-01-01—2011-08-31,纳入加拿大6家医院的急诊科,对其中3家医院的急诊科施加连续26周的干预(干预组),共包括3个阶段:第1阶段不施加干预,第2阶段施用低风险踝部规则(包括医生教育、提醒和计算机化对策支持系统),第3阶段仅提供计算机化对策支持系统;另3家医院的急诊科作为对照,不施加干预(对照组)。调查这6家医院急诊科3~16岁儿童踝部损伤的医疗管理情况及儿童进行X线检查的频率。结果共纳入2 151例踝部损伤儿童,其中干预组1 055例,对照组1 096例。在第1阶段,干预组和对照组儿童进行X线检查的频率分别为96.5%和90.2%;在第2阶段,干预组儿童进行X线检查的频率较对照组明显减少〔组间差异=-21.9%,95%CI(-28.6%,-15.2%)〕,而两组患者及医生满意度间未见明显差异;在第3阶段,干预所产生的作用依然保持着。低风险踝部规则的灵敏度为100%〔95%CI(85.4%,100%)〕,特异度为53.1%〔95%CI(48.1%,58.1%)〕。解释施用低风险踝部规则的急诊科明显并安全地减少了儿童踝部损伤的X线检查频率,且不影响医生或患者的满意度。
Background Low risk ankle rule is a rule on effective clinical decision making that makes it possible to safely reduce the frequency of X-ray examinations of acute ankle injuries in children. The researchers evaluated the phased application of the low-risk ankle rule and its role in reducing the frequency of X-rays in children with ankle injury. Methods 2009-01-01-2011-08-31, included in the emergency department of six Canadian hospitals, implanted 26 consecutive interventions (intervention group) in the emergency department of three of the three hospitals, including three phases: the first phase In the second phase, low-risk ankle rule (including doctor education, reminders and computerized support system) was applied in the second phase. Only the computerized supportive support system was provided in the third phase. In the other three hospitals, the emergency department was used as a control without applying Intervention (control group). Investigate the medical management of ankle injury in children aged 3-16 years in these six hospital emergency departments and the frequency of X-ray examinations performed by children. Results A total of 2 151 children with ankle injuries were enrolled in this study, including 1 055 in the intervention group and 1 096 in the control group. In stage 1, the frequencies of X-ray examination in intervention group and control group were 96.5% and 90.2% respectively; in the second stage, the frequency of X-ray examination in intervention group was significantly lower than that in control group [difference between groups = 21.9%, 95% CI (-28.6%, -15.2%)]. There was no significant difference in satisfaction between the two groups of patients and doctors. In the third phase, the effect of intervention was still maintained. The low-risk ankle rule had a sensitivity of 100% [95% CI (85.4%, 100%)] and a specificity of 53.1% [95% CI (48.1%, 58.1%)]. Interpreting the emergency department applying the low-risk ankle rule significantly and safely reduces the frequency of X-rays of the ankle injury in children without affecting the physician or patient’s satisfaction.