眼眶骨折临床决策规则制定：疾病负担和强制性电子调查工具的使用。
Orbital fracture clinical decision rule development: burden of disease and use of a mandatory electronic survey instrument.
机构信息
Department of Emergency Medicine, The George Washington University, Washington, DC, USA.
出版信息
Acad Emerg Med. 2011 Mar;18(3):313-6. doi: 10.1111/j.1553-2712.2011.01017.x. Epub 2011 Feb 25.
OBJECTIVES
In preparation for development of a clinical decision rule (CDR) to promote more efficient use of computed tomography (CT) for diagnosing orbital fractures, the authors sought to estimate the annual incidence of orbital fractures in emergency departments (EDs) and the usage of CT to make these diagnoses. The authors also sought to evaluate a mandatory electronic data collection instrument (EDCI) administered to providers to facilitate CDR data collection.
METHODS
National estimates were made by analyzing the 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS) database, while hospital billing system and coding data were used to make local estimates. An EDCI was integrated into the CT ordering system such that providers had to complete the form to perform a CT. Because the EDCI had to be filled out for every CT ordered, data collection efficiency was measured by compliance (counting the number of unrealistic data collection instrument answers) and by timing a convenience sample of providers completing the EDCI.
RESULTS
Out of 116.8 million ED visits in the United States in 2007, 4.1 million patients were treated for injuries of the eye and face. Of those, 820,252 patients underwent CT imaging, with 102,999 patients (12.5%) diagnosed with an orbital fracture. In our local hospital system with 122,500 annual ED visits, 752 CTs of orbits were performed, with 172 (23%) orbital fractures. The EDCI compliance rate was 94.9% and took less than 5 minutes to complete.
CONCLUSIONS
National and local data demonstrate a low yield for CT imaging in identifying orbital fractures. Data collection using a mandatory EDCI linked to computerized provider order entry can provide prospective, consecutive patient data that are needed to develop a CDR for the selective use of CT imaging in orbital trauma. Such a decision rule could increase the efficiency in diagnosing orbital fractures, thereby improving patient care, reducing radiation exposure, and decreasing costs.
目的
为了制定一个临床决策规则（CDR），以促进更有效地利用计算机断层扫描（CT）诊断眼眶骨折，作者旨在估计急诊部（ED）中眼眶骨折的年发生率以及用于诊断这些骨折的 CT 的使用情况。作者还评估了一种强制性电子数据采集工具（EDCI），该工具用于为 CDR 数据采集提供便利。
方法
通过分析 2007 年国家医院门诊医疗调查（NHAMCS）数据库进行全国估计，同时使用医院计费系统和编码数据进行本地估计。将 EDCI 集成到 CT 订购系统中，以便提供者必须完成表格才能进行 CT。由于 EDCI 必须为每个订购的 CT 填写，因此通过合规性（计算不切实际的数据采集工具答案的数量）和通过对方便抽样的提供者完成 EDCI 的时间来衡量数据收集效率。
结果
在 2007 年美国 1.168 亿次 ED 就诊中，有 410 万名患者因眼部和面部受伤接受治疗。其中，有 820252 名患者接受了 CT 成像，有 102999 名患者（12.5%）被诊断为眼眶骨折。在我们的本地医院系统中，有 122500 名年度 ED 就诊者，进行了 752 次眼眶 CT 检查，有 172 例（23%）眼眶骨折。EDCI 合规率为 94.9%，完成时间不到 5 分钟。
结论
国家和本地数据表明，CT 成像在识别眼眶骨折方面的收益较低。使用与计算机化提供者订单输入链接的强制性 EDCI 进行数据采集，可以提供前瞻性、连续的患者数据，这些数据是为选择性使用 CT 成像诊断眼眶创伤制定 CDR 所必需的。这样的决策规则可以提高诊断眼眶骨折的效率，从而改善患者护理，减少辐射暴露，降低成本。
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