将低风险踝关节规则引入儿科急诊。

Introduction of the low risk ankle rule to a paediatric emergency department.

机构信息

Emergency Department, Temple Street Hospital, Dublin, Ireland.

出版信息

Injury. 2020 Mar;51(3):633-635. doi: 10.1016/j.injury.2020.01.040. Epub 2020 Feb 1.

DOI:10.1016/j.injury.2020.01.040

PMID:32037005

Abstract

INTRODUCTION

Ankle injuries are a common presentation to the paediatric emergency department (PED), accounting for approximately 2% of presentations. X-rays are ordered for 85-95% of patients but only 12% of x-rays reveal a fracture. Clinical prediction rules, such as The Low Risk Ankle Rule (LRAR) exist to help clinicians safely reduce the frequency of radiography in these injuries. The LRAR has been shown to reduce imaging by up to 60% without missing any clinically significant fractures. We sought to introduce The LRAR into our department and study its outcomes on our practice.

AIMS

To introduce the LRAR into our department and study its effects on our radiography rate and length of stay (LOS).

METHODS

An audit of x-ray rates in ankle injuries in 2016 was performed to determine our department's baseline rate of radiography and LOS. We then conducted education sessions and created x-ray ordering prompts to encourage clinicians to use the LRAR. We introduced the LRAR, with a pilot period initially, and gathered data prospectively.

RESULTS

969 patients presented in with an ankle injury in 2016, 90.7% of these patients had an x-ray. The median LOS was 109 min. 92 patients presented during the LRAR implementation period with an ankle injury. Nine patients had exclusion criteria from using the LRAR and the attending physician did not use the LRAR in four patients. Of the remaining 79 patients, 49 had a LRAR positive exam. Only one of these patients went on to have an x-ray, which was normal. The 30 patients with a LRAR negative exam all had an x-ray. Overall, our x-ray rate during the study period was 40/92 (43.4%), a reduction of 47.3%. The average LOS during the study was 101 min. No clinically significant fractures were missed.

CONCLUSION

The LRAR can safely and effectively reduce the rate of radiography in ankle injuries, without missing any clinically significant fractures.

摘要

介绍

踝关节损伤是儿科急诊部（PED）的常见就诊原因，占就诊量的约 2%。85-95%的患者会进行 X 光检查，但只有 12%的 X 光检查显示骨折。临床预测规则，如低风险踝关节规则（LRAR），可帮助临床医生安全地减少这些损伤的 X 光检查频率。LRAR 已被证明可将影像学检查减少多达 60%，而不会漏诊任何具有临床意义的骨折。我们试图在我们的科室引入 LRAR，并研究其对我们的放射学检查率和住院时间（LOS）的影响。

目的

将 LRAR 引入我们的科室，并研究其对我们的放射学检查率和 LOS 的影响。

方法

对 2016 年踝关节损伤的 X 射线检查率进行审核，以确定我们科室的放射学检查率和 LOS 的基线水平。然后，我们进行了教育课程，并创建了 X 射线检查的提示，以鼓励临床医生使用 LRAR。我们引入了 LRAR，最初有一个试点阶段，并进行了前瞻性数据收集。

结果

2016 年，969 名患者因踝关节损伤就诊，其中 90.7%的患者进行了 X 射线检查。中位 LOS 为 109 分钟。92 名患者在 LRAR 实施期间因踝关节损伤就诊。9 名患者因使用 LRAR 存在排除标准，而 4 名患者的主治医生未使用 LRAR。在剩余的 79 名患者中，有 49 名 LRAR 检查阳性。只有 1 名患者的 X 射线检查结果正常。30 名 LRAR 检查阴性的患者均进行了 X 射线检查。总的来说，在研究期间，我们的 X 射线检查率为 40/92（43.4%），减少了 47.3%。研究期间的平均 LOS 为 101 分钟。没有漏诊任何具有临床意义的骨折。