Eagles Debra, Stiell Ian G, Clement Catherine M, Brehaut Jamie, Taljaard Monica, Kelly Anne-Maree, Mason Suzanne, Kellermann Arthur, Perry Jeffrey J
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Acad Emerg Med. 2008 Dec;15(12):1256-61. doi: 10.1111/j.1553-2712.2008.00265.x. Epub 2008 Oct 17.
The derivation and validation studies for the Canadian Cervical-Spine (C-Spine) Rule (CCR) and the Canadian Computed Tomography (CT) Head Rule (CCHR) have been published in major medical journals. The objectives were to determine: 1) physician awareness and use of these rules in Australasia, Canada, the United Kingdom, and the United States and 2) physician characteristics associated with awareness and use.
A self-administered e-mail and postal survey was sent to members of four national emergency physician (EP) associations using a modified Dillman technique. Results were analyzed using repeated-measures logistic regression models.
The response rate was 54.8% (1,150/2,100). Reported awareness of the CCR ranged from 97% (Canada) to 65% (United States); for the CCHR it ranged from 86% (Canada) to 31% (United States). Reported use of the CCR ranged from 73% (Canada) to 30% (United States); for the CCHR, it was 57% (Canada) to 12% (United States). Predictors of awareness were country, type of rule, full-time employment, younger age, and teaching hospital (p < 0.05). Significant differences in use of the CCR by country were observed, but not for the CCHR. Teaching hospitals were more likely to use the CCR than nonteaching hospitals, but less likely to use the CCHR.
This large international study found notable differences among countries with regard to knowledge and use of the CCR and CCHR. Awareness and use of both rules were highest in Canada and lowest in the United States. While younger physicians, those employed full-time, and those working in teaching hospitals were more likely to be aware of a decision rule, age and employment status were not significant predictors of use. A better understanding of factors related to awareness and use of emergency medicine (EM) decision rules will enhance our understanding of knowledge translation and facilitate strategies to enhance dissemination and implementation of future rules.
加拿大颈椎（C 脊柱）规则（CCR）和加拿大计算机断层扫描（CT）头部规则（CCHR）的推导和验证研究已发表在主要医学期刊上。目的是确定：1）澳大利亚、加拿大、英国和美国医生对这些规则的知晓程度和使用情况，以及 2）与知晓和使用相关的医生特征。
采用改良的迪尔曼技术，通过电子邮件和邮寄方式向四个国家急诊医师（EP）协会的成员发送了一份自填式调查问卷。使用重复测量逻辑回归模型对结果进行分析。
回复率为 54.8%（1150/2100）。报告的 CCR 知晓率从 97%（加拿大）到 65%（美国）不等；CCHR 的知晓率从 86%（加拿大）到 31%（美国）不等。报告的 CCR 使用情况从 73%（加拿大）到 30%（美国）不等；CCHR 的使用情况为 57%（加拿大）到 12%（美国）。知晓情况的预测因素包括国家、规则类型、全职工作、年龄较小以及教学医院（p < 0.05）。观察到各国在 CCR 使用方面存在显著差异，但 CCHR 没有。教学医院比非教学医院更有可能使用 CCR，但使用 CCHR 的可能性较小。
这项大型国际研究发现，各国在 CCR 和 CCHR 的知识和使用方面存在显著差异。这两项规则的知晓率和使用率在加拿大最高，在美国最低。虽然年轻医生、全职工作的医生以及在教学医院工作的医生更有可能知晓决策规则，但年龄和就业状况并非使用的重要预测因素。更好地理解与急诊医学（EM）决策规则的知晓和使用相关的因素，将增进我们对知识转化的理解，并促进提高未来规则传播和实施的策略。
