Gomes Yolanda E, Chau Minh, Banwell Helen A, Davies Josephine, Causby Ryan S
Allied Health and Human Performance Unit, University of South Australia, Adelaide, South Australia, Australia.
South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, South Australia, Australia.
PeerJ. 2020 Oct 8;8:e10152. doi: 10.7717/peerj.10152. eCollection 2020.
To assess the adequacy of clinical information with reference to the Ottawa Ankle Rules (OAR) in X-ray referrals for adults with traumatic ankle injury in the ED of a South Australian tertiary hospital and report upon referring trends between emergency department clinicians.
A retrospective clinical audit of adult ankle X-ray referrals in the emergency department was conducted. Eligible referrals were screened for their adherence to the OAR, patient details, clinical history and referrer. A logistic regression was used to determine the influence of these factors on the likelihood of being referred for X-rays despite not meeting the OAR criteria. Sensitivity, specificity, positive and negative likelihood ratios and their associated confidence intervals were calculated to assess the diagnostic accuracy of the OAR for those referred.
Out of the 262 eligible referrals, 163 were deemed to have met the criteria for the OAR. Physiotherapists showed the highest OAR compliance of 77.3% and were the most accurate in their use of the rules, with a sensitivity of 0.86. Medical officers, registrars and interns were 2.5 times more likely to still refer a patient for X-ray if they did not meet the OAR criteria, compared to physiotherapists as the baseline. Patient age, duration of injury etc. were not significantly associated with likelihood of referral (even when they did not meet OAR criteria). The overall sensitivity, specificity, positive and negative likelihood ratios of the OAR were 0.59 (95% CI [0.47-0.71]), 0.37 (95% CI [0.30-0.44]), 0.93 (95% CI [0.76-1.16]) and 1.10 (95% CI [0.82-1.48]) respectively.
The results of this audit demonstrated poor sensitivity and moderate compliance by referrers with the rule. Reasonable evidence exists for the implementation of individual and/or institutional-based change strategies to improve clinician compliance and accuracy with use of the OAR.
评估南澳大利亚一家三级医院急诊科成人创伤性踝关节损伤X线检查转诊中，参照渥太华踝关节规则（OAR）的临床信息是否充分，并报告急诊科临床医生之间的转诊趋势。
对急诊科成人踝关节X线转诊进行回顾性临床审计。对符合条件的转诊病例进行筛查，检查其是否遵循OAR、患者详细信息、临床病史和转诊医生情况。采用逻辑回归分析来确定这些因素对尽管未符合OAR标准但仍被转诊进行X线检查可能性的影响。计算敏感性、特异性、阳性和阴性似然比及其相关置信区间，以评估OAR对被转诊者的诊断准确性。
在262例符合条件的转诊病例中，163例被认为符合OAR标准。物理治疗师的OAR依从性最高，为77.3%，并且在使用该规则方面最准确，敏感性为0.86。与作为基线的物理治疗师相比，如果不符合OAR标准，医疗官员、住院医生和实习医生转诊患者进行X线检查的可能性要高出2.5倍。患者年龄、受伤持续时间等与转诊可能性无显著关联（即使他们不符合OAR标准）。OAR的总体敏感性、特异性、阳性和阴性似然比分别为0.59（95%CI[0.47 - 0.71]）、0.37（95%CI[0.30 - 0.44]）、0.93（95%CI[0.76 - 1.16]）和1.10（95%CI[0.82 - 1.48]）。
本次审计结果显示该规则的敏感性较差，转诊者的依从性一般。有合理证据表明应实施基于个人和/或机构的变革策略，以提高临床医生对OAR的依从性和使用准确性。
