Bolvardi Ehsan, Alizadeh Behnaz, Foroughian Mahdi, Abbasi Bita, Habibzadeh Seyed Reza, Akhavan Reza
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.
Department of Radiology, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.
Arch Acad Emerg Med. 2019 Feb 15;7(1):e21. eCollection 2019.
The Quebec Decision Rule (QDR) has been developed for deciding on the necessity of radiography for patients with shoulder dislocation. This study aimed to investigate the diagnostic value of QDR in this regard.
This diagnostic accuracy study was conducted on patients with shoulder dislocation visiting the emergency department. After filling out the QDR-based checklist for all patients, they underwent radiography and the obtained radiography results were compared to QDR-based clinical diagnostic findings.
143 patients with the mean age of 32.1±12 years were evaluated (88.8% males). Sensitivity, specificity, and positive and negative predictive values of QDR were 50%, 58.2%, 3.3%, and 97.6%, respectively. The sensitivity and specificity were 100% and 50% in patients >40 years old, and 33.3% and 59.8% in those <40 years old. These indices were 33.3% and 60.4%, respectively, in the male sex and 100% and 40% in the female sex.
Quebec decision rule holds promise to diagnose concomitant fractures in patients over the age of 40 with 100% sensitivity, thereby reducing the number of radiographies by 50% without causing diagnostic errors. In contrast, this criterion proved inefficient in patients younger than 40. .
魁北克决策规则（QDR）已被制定用于判定肩关节脱位患者是否需要进行放射检查。本研究旨在探讨QDR在这方面的诊断价值。
本诊断准确性研究针对前往急诊科就诊的肩关节脱位患者开展。在为所有患者填写基于QDR的检查表后，他们接受了放射检查，并将获得的放射检查结果与基于QDR的临床诊断结果进行比较。
共评估了143例患者，平均年龄为32.1±12岁（男性占88.8%）。QDR的敏感性、特异性、阳性预测值和阴性预测值分别为50%、58.2%、3.3%和97.6%。40岁以上患者的敏感性和特异性分别为100%和50%，40岁以下患者则分别为33.3%和59.8%。这些指标在男性中分别为33.3%和60.4%，在女性中分别为100%和40%。
魁北克决策规则有望以100%的敏感性诊断40岁以上患者的并发骨折，从而减少50%的放射检查次数且不导致诊断错误。相比之下，该标准在40岁以下患者中被证明效率低下。
