Paek So Hyun, Jung Jin Hee, Kwak Young Ho, Kim Do Kyun, Lee Jin Hee, Jung Jae Yun, Oh Sohee
From the Department of Emergency Medicines, Seoul National University Hospital, Seoul.
Department of Emergency Medicines, SMG-SNU Boramae Medical Center, and Department of Preventive Medicine, Kangwon National University, School of Medicine, Chuncheon.
Pediatr Emerg Care. 2020 May;36(5):e280-e284. doi: 10.1097/PEC.0000000000001300.
Head and face injuries are leading causes of emergency department visits in children. There is yet no clinical decision rule on face CT such as pediatric head CT rules. The goal was to develop and validate a clinical decision rule for identifying orbital wall fractures in children with periorbital trauma in the emergency department.
This was a retrospective derivation and validation study. Children younger than 18 years who underwent orbit CT after periorbital trauma were included between January 2011 and December 2013 in 3 emergency centers. Among 16 candidate clinical variables, 13 clinical signs and symptoms were selected as clinical predictors. For the fracture model, these clinical predictors were analyzed by 3-fold cross-validation. Diagnostic performance was assessed using the area under the receiver operating characteristic (AUROC) curve in both cohorts.
Four variables (orbital rim tenderness, periorbital ecchymosis, painful extraocular movement, and nausea/vomiting) had the best predictive model with the highest AUROC value. The AUROC values for fracture prediction were 0.793 (95% confidence interval, 0.741-0.844) and 0.809 (95% confidence interval, 0.742-0.877) in the derivation cohort and validation cohort, respectively. The sensitivity and negative predictive values were 96.4% and 93.4%, respectively, in the derivation cohort, and 97.8% and 98.1%, respectively, in the validation cohort. The sum of these scores ranged from 0 to 4. Patients with a sum of scores of 1 or higher showed significantly increased risk for fracture.
The 4-variable predictive model can be useful for finding clinically important orbital wall fractures in children.
头面部损伤是儿童急诊就诊的主要原因。目前尚无类似儿科头部CT规则的面部CT临床决策规则。本研究旨在制定并验证一项用于识别急诊科眼眶周围创伤儿童眼眶壁骨折的临床决策规则。
这是一项回顾性推导和验证研究。纳入2011年1月至2013年12月期间在3个急诊中心因眼眶周围创伤接受眼眶CT检查的18岁以下儿童。在16个候选临床变量中，选择13项临床体征和症状作为临床预测指标。对于骨折模型，通过3折交叉验证对这些临床预测指标进行分析。在两个队列中均使用受试者操作特征曲线下面积（AUROC）评估诊断性能。
四个变量（眶缘压痛、眶周瘀斑、眼球运动疼痛和恶心/呕吐）具有最佳预测模型，AUROC值最高。推导队列和验证队列中骨折预测的AUROC值分别为0.793（95%置信区间，0.741 - 0.844）和0.809（95%置信区间，0.742 - 0.877）。推导队列中的敏感性和阴性预测值分别为96.4%和93.4%，验证队列中分别为97.8%和98.1%。这些分数的总和范围为0至4。分数总和为1或更高的患者骨折风险显著增加。
该四变量预测模型有助于发现儿童临床上重要的眼眶壁骨折。
