Strudwick Kirsten, Nelson Mark, Martin-Khan Melinda, Bourke Michael, Bell Anthony, Russell Trevor
The Physiotherapy Department, QEII Jubilee Hospital, Metro South Health, Queensland, Australia; The Emergency Department, QEII Jubilee Hospital, Metro South Health, Queensland, Australia; The Division of Physiotherapy, School of Health and Rehabilitation Sciences The University of Queensland, Queensland, Australia.
Acad Emerg Med. 2015 Feb;22(2):127-41. doi: 10.1111/acem.12591. Epub 2015 Feb 9.
There is increasing importance placed on quality of health care for musculoskeletal injuries in emergency departments (EDs). This systematic review aimed to identify existing musculoskeletal quality indicators (QIs) developed for ED use and to critically evaluate their methodological quality.
MEDLINE, EMBASE, CINAHL, and the gray literature, including relevant organizational websites, were searched in 2013. English-language articles were included that described the development of at least one QI related to the ED care of musculoskeletal injuries. Data extraction of each included article was conducted. A quality assessment was then performed by rating each relevant QI against the Appraisal of Indicators through Research and Evaluation (AIRE) Instrument. QIs with similar definitions were grouped together and categorized according to the health care quality frameworks of Donabedian and the Institute of Medicine.
The search revealed 1,805 potentially relevant articles, of which 15 were finally included in the review. The number of relevant QIs per article ranged from one to 11, resulting in a total of 71 QIs overall. Pain (n = 17) and fracture management (n = 13) QIs were predominant. Ten QIs scored at least 50% across all AIRE Instrument domains, and these related to pain management and appropriate imaging of the spine.
Methodological quality of the development of most QIs is poor. Recommendations for a core set of QIs that address the complete spectrum of musculoskeletal injury management in emergency medicine is not possible, and more work is needed. Currently, QIs with highest methodological quality are in the areas of pain management and medical imaging.
急诊科对肌肉骨骼损伤的医疗质量愈发受到重视。本系统评价旨在识别已制定的用于急诊科的肌肉骨骼质量指标（QIs），并严格评估其方法学质量。
2013年检索了MEDLINE、EMBASE、CINAHL以及灰色文献，包括相关组织网站。纳入描述至少一项与急诊科肌肉骨骼损伤护理相关的质量指标制定情况的英文文章。对每篇纳入文章进行数据提取。然后通过使用“通过研究和评估进行指标评估”（AIRE）工具对每个相关质量指标进行评分来进行质量评估。定义相似的质量指标被归为一组，并根据唐纳贝迪安和医学研究所的医疗质量框架进行分类。
检索发现1805篇潜在相关文章，其中15篇最终纳入本评价。每篇文章的相关质量指标数量从1个到11个不等，总共71个质量指标。疼痛（n = 17）和骨折处理（n = 13）质量指标占主导。10个质量指标在所有AIRE工具领域的得分至少为50%，这些指标与疼痛管理和脊柱的适当影像学检查有关。
大多数质量指标的制定方法学质量较差。由于无法就一套涵盖急诊医学中肌肉骨骼损伤管理全范围的核心质量指标提出建议，因此还需要开展更多工作。目前，方法学质量最高的质量指标在疼痛管理和医学影像学领域。
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