循证实践：急诊医师对儿童常见骨折的处理

Evidence into practice: emergency physician management of common pediatric fractures.

作者信息

Boutis Kathy, Howard Andrew, Constantine Erika, Cuomo Anna, Narayanan Unni

机构信息

From the *Division of Emergency Medicine, Department of Pediatrics, and †Division of Orthopedic Surgery, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; ‡Departments of Emergency Medicine and Pediatrics, Section of Pediatric Emergency Medicine, Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI; and §Department of Orthopedic Surgery, Shriners Hospital for Children (Los Angeles), University of California Los Angeles, Los Angeles, CA.

出版信息

Pediatr Emerg Care. 2014 Jul;30(7):462-8. doi: 10.1097/PEC.0000000000000162.

DOI:10.1097/PEC.0000000000000162

PMID:24977995

Abstract

OBJECTIVES

Randomized trials have shown that removable immobilization devices are at least as good as circumferential casts for the management of common specific types of pediatric wrist and ankle fractures. Our main objective was to determine the proportion of emergency physicians who prescribe removable devices for distal radius buckle fractures and/or nondisplaced distal fibular Salter-Harris I fractures. We also examined follow-up referral patterns for these injuries.

METHODS

This was an online survey of members of 2 national emergency physician associations in Canada: Pediatric Emergency Research Canada and the Canadian Association of Emergency Physicians.

RESULTS

Of the 849 eligible participants, 447 responded to the survey, yielding an aggregate response rate of 52.7%. Organization-specific response rates were 169 (70.4%) of 240 for the Pediatric Emergency Research Canada and 278 (45.6%) of 609 for the Canadian Association of Emergency Physicians. Overall, 263 of 416 (63.2%; 95% confidence interval [CI], 58.6-67.8) of emergency physicians treat buckle fractures of the distal radius with a removable splint and refer 212 of 398 (53.3%; 95% CI, 48.4-58.2) of these injuries to the primary care physician for follow-up. For Salter-Harris I fractures of the distal fibula, emergency physicians treat 201 of 416 (48.3%; 95% CI, 43.5-53.1) with a removable ankle support and refer 94 of 398 (23.6%; 95% CI, 19.4-27.8) to the primary care physician for follow-up.

CONCLUSIONS

At least 50% of the surveyed Canadian emergency physicians treat distal radius buckle fractures and/or Salter-Harris I fibular fractures with a removable immobilization device, and the primary care physician follow-up of these injuries occur with some regularity for both these injuries.

摘要

目的

随机试验表明，对于常见的特定类型小儿手腕和脚踝骨折的治疗，可移除固定装置至少与环形石膏一样有效。我们的主要目的是确定为桡骨远端青枝骨折和/或无移位的腓骨远端Salter-Harris I型骨折开具可移除装置的急诊医生比例。我们还研究了这些损伤的后续转诊模式。

方法

这是一项针对加拿大两个全国急诊医生协会成员的在线调查：加拿大儿科急诊研究协会和加拿大急诊医生协会。

结果

在849名符合条件的参与者中，447人回复了调查，总回复率为52.7%。加拿大儿科急诊研究协会的组织特定回复率为240人中的169人（70.4%），加拿大急诊医生协会的组织特定回复率为609人中的278人（45.6%）。总体而言，416名急诊医生中有263人（63.2%；95%置信区间[CI]，58.6-67.8）用可移除夹板治疗桡骨远端青枝骨折，并将其中398例损伤中的212例（53.3%；95%CI，48.4-58.2）转诊给初级保健医生进行随访。对于腓骨远端Salter-Harris I型骨折，急诊医生用可移除的脚踝支撑物治疗416例中的201例（48.3%；95%CI，43.5-53.1），并将398例中的94例（23.6%；95%CI，19.4-27.8）转诊给初级保健医生进行随访。