Klemetti Sanna, Uhari Matti, Pokka Tytti, Rantala Heikki
Department of Pediatrics, University of Oulu, Oulu 90014, Finland.
Pediatr Emerg Care. 2009 Dec;25(12):811-5. doi: 10.1097/PEC.0b013e3181c32e74.
We evaluated the existing decision rules and developed our own decision rule for use with pediatric patients having head injuries to see how good they are for identifying serious complications.
In a retrospective survey covering 5 years, we tested 3 decision rules on all the 485 children with head trauma admitted to the Department of Pediatrics at Oulu University Hospital in Finland.
Four hundred two (83%) of our 485 patients had uncomplicated head trauma, 55 (11%) had complicated trauma, and 28 (6%) had severely complicated trauma. We found the 3 existing decision rules to be applicable with 96% to 99% sensitivities in identifying patients with at least complicated head trauma and 100% sensitivity in identifying severely complicated cases, but the specificities were low, from 5% to 21%. Use of the best National Emergency X-Radiography Utilization Study (NEXUS) II decision rule would have resulted in 89 (18%) less hospital admissions, 216 (14%) less days in the hospital, and annual savings of 30,600 dollars without compromising the prognosis for our patients. A decision rule developed on the basis of our own series had a sensitivity of 94% for patients with at least complicated head trauma and 96% for patients with severely complicated head trauma and a specificity of 29% in both groups.
All the 3 existing decision rules tested had high sensitivities for at least complicated head trauma, but rather low specificity. Because the most optimal decision rule based on the present data was not superior to the existing ones, we conclude that it is difficult to develop a rule that would be markedly better than that of NEXUS II. Use of the NEXUS II rule would have resulted in reduced hospitalization and imaging rates in our hospital, where no decision rules are currently used.
我们评估了现有的决策规则，并制定了自己的决策规则，用于头部受伤的儿科患者，以了解它们在识别严重并发症方面的效果如何。
在一项涵盖5年的回顾性调查中，我们对芬兰奥卢大学医院儿科收治的485例头部创伤儿童测试了3种决策规则。
我们的485例患者中，402例（83%）头部创伤无并发症，55例（11%）有并发症，28例（6%）有严重并发症。我们发现，3种现有决策规则在识别至少有并发症的头部创伤患者时，敏感性为96%至99%，在识别严重并发症病例时敏感性为100%，但特异性较低，为5%至21%。使用最佳的国家急诊X线摄影利用研究（NEXUS）II决策规则，将减少89例（18%）住院病例、216天（14%）住院天数，每年节省30600美元，且不影响患者预后。基于我们自己的病例系列制定的决策规则，对于至少有并发症的头部创伤患者敏感性为94%，对于严重并发症患者敏感性为96%，两组的特异性均为29%。
所测试的3种现有决策规则对至少有并发症的头部创伤均有较高敏感性，但特异性较低。由于基于目前数据的最优决策规则并不优于现有规则，我们得出结论，很难制定出明显优于NEXUS II的规则。在我们医院目前未使用决策规则的情况下，使用NEXUS II规则将降低住院率和影像检查率。
