Gravel Jocelyn, Gouin Serge, Canuel Annie, Mâsse Benoît
Montréal, Canada.
Montréal, Canada.
J Emerg Nurs. 2018 Mar;44(2):164-168. doi: 10.1016/j.jen.2017.06.013. Epub 2017 Jul 27.
The C-3PO rule has been validated for use by emergency physicians to identify young children at risk of skull fracture following head trauma. The use of the rule by triage nurses could improve patient flow in the emergency department.
To evaluate the interobserver agreement of triage nurses and emergency physicians in the interpretation of the C-3PO rule in a pediatric emergency department.
This was a prospective observational study performed in a consecutive sample of children visiting a single emergency department. Participants were all children younger than 24 months of age who presented at the emergency department for head trauma that had occurred in the previous 24 hours. The primary outcome was the interobserver agreement between nurses and emergency physicians as to whether the child was at high risk of skull fracture according to the interpretation of the C-3PO rule. All study participants were evaluated sequentially by a triage nurse and an emergency physician. Outcome of evaluation was kept blinded between nurses and physicians. The primary analysis was the interrater reliability using the kappa score. The sample size was set to provide lower boundary of 0.70 for a 95% confidence interval (95% CI) for kappa coefficient of at least 0.80.
A total of 226 children were evaluated by a physician and a nurse. Among them, 10 had skull fractures. A total of 34 nurses and 42 physicians evaluated between 1 and 21 children. The interrater reliability was excellent, as demonstrated by a kappa score of 0.85 (95% CI: 0.77-0.92). Moreover, all children with skull fractures were categorized at "high risk" by the nurse and the physician.
This study demonstrates an almost perfect interrater reliability between triage nurses and emergency physicians in interpreting the C-3PO rule when evaluating children who presented at an emergency department for head trauma. Contribution to Emergency Nursing Practice.
C-3PO 规则已被证实可供急诊医生用于识别头部外伤后有颅骨骨折风险的幼儿。分诊护士使用该规则可改善急诊科的患者流程。
评估儿科急诊科分诊护士和急诊医生在解读 C-3PO 规则方面的观察者间一致性。
这是一项前瞻性观察性研究，对连续就诊于单一急诊科的儿童样本进行研究。参与者为所有 24 个月以下、因前 24 小时内发生的头部外伤而到急诊科就诊的儿童。主要结局是护士和急诊医生根据 C-3PO 规则的解读判断儿童是否有高颅骨骨折风险的观察者间一致性。所有研究参与者均由分诊护士和急诊医生依次进行评估。护士和医生之间对评估结果保持盲态。主要分析是使用卡帕分数的评分者间信度。样本量设定为使卡帕系数至少为 0.80 的 95%置信区间（95%CI）的下限为 0.70。
共有 226 名儿童由医生和护士进行了评估。其中，10 名儿童有颅骨骨折。共有 34 名护士和 42 名医生评估了 1 至 21 名儿童。评分者间信度极佳，卡帕分数为 0.85（95%CI：0.77 - 0.92）。此外，所有有颅骨骨折的儿童被护士和医生均归类为“高风险”。
本研究表明，在评估因头部外伤到急诊科就诊的儿童时，分诊护士和急诊医生在解读 C-3PO 规则方面具有几乎完美的评分者间信度。对急诊护理实践的贡献。
