Brehaut Jamie C, Stiell Ian G, Visentin Laura, Graham Ian D
Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada.
Acad Emerg Med. 2005 Oct;12(10):948-56. doi: 10.1197/j.aem.2005.04.024. Epub 2005 Sep 15.
Widespread, appropriate use of clinical decision rules would result in many benefits for health care. While it is known that clinicians report using these rules, little is known about how the rules are actually used in everyday practice.
To conduct a survey of emergency physicians to examine whether they use the Ottawa Ankle Rules (OAR) consistently, exclusively, and accurately.
A postal survey was administered to 399 emergency physicians randomly selected from the membership list of the Canadian Association of Emergency Physicians using Dillman's tailored design method for postal surveys. Results were analyzed via frequency distributions and linear regression.
Response rate was 69.7% (262 of 376 eligible respondents), of whom 99.2% were familiar with the OAR. Most physicians (89.6%) reported using the OAR always or most of the time in appropriate circumstances, while only 42.2% reported basing their decisions to order radiography primarily on the rule. Physicians reported considering non-rule factors that are not related to the presence of a fracture (e.g., swelling: 54%), and factors that add no more predictive value over and above the rule (e.g., age >55 years: 55.2%). While 82.4% reported not having reviewed the rule for months or years, only 30.9% of the respondents were able to correctly remember the components of the rule. Errors in remembering rule components were more common among part-time (beta = 0.18, p = 0.009) and older (beta = 0.18, p = 0.04) physicians, and those who do not apply the rule consistently (beta = 0.14, p = 0.04).
Most physicians report using and applying the OAR consistently, but most report that the rule is not the primary determinant of their decisions. Most apply this rule without referring to memory aids, yet their memory for this simple rule is imperfect. Future work should study how different memory aid strategies might improve the accuracy of rule application and reduce the use of nonpredictive cues.
临床决策规则的广泛、合理应用将给医疗保健带来诸多益处。虽然已知临床医生报告使用这些规则，但对于这些规则在日常实践中实际如何使用却知之甚少。
对急诊医生进行一项调查，以检查他们是否始终如一地、专门地且准确地使用渥太华踝关节规则（OAR）。
采用迪尔曼针对邮寄调查的量身定制设计方法，对从加拿大急诊医生协会会员名单中随机抽取的399名急诊医生进行邮寄调查。通过频率分布和线性回归分析结果。
回复率为69.7%（376名符合条件的受访者中有262人回复），其中99.2%的人熟悉OAR。大多数医生（89.6%）报告在适当情况下总是或大部分时间使用OAR，而只有42.2%的人报告其开具X光检查的决定主要基于该规则。医生们报告考虑了与骨折存在无关的非规则因素（如肿胀：54%），以及在规则之外没有更多预测价值的因素（如年龄>55岁：55.2%）。虽然82.4%的人报告数月或数年未复习该规则，但只有30.9%的受访者能够正确记住该规则的组成部分。在兼职医生（β = 0.18，p = 0.009）、年长医生（β = 0.18，p = 0.04）以及那些并非始终应用该规则的医生（β = 0.14，p = 0.04）中，记住规则组成部分的错误更为常见。
大多数医生报告始终如一地使用和应用OAR，但大多数人报告该规则并非其决策的主要决定因素。大多数人在不参考记忆辅助工具的情况下应用此规则，然而他们对这个简单规则的记忆并不完美。未来的工作应研究不同的记忆辅助策略如何可能提高规则应用的准确性并减少非预测性线索的使用。
