一种用于辨别需要治疗的中面部和下颌骨骨折与无需治疗的中面部和下颌骨骨折患者的临床决策辅助工具（REDOUCION-II 研究）：一项前瞻性多中心队列研究。
A clinical decision aid to discern patients without and with midfacial and mandibular fractures that require treatment (the REDUCTION-II study): a prospective multicentre cohort study.
机构信息
Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
出版信息
Eur J Trauma Emerg Surg. 2022 Aug;48(4):2547-2558. doi: 10.1007/s00068-022-01892-4. Epub 2022 Feb 24.
PURPOSE
To assess the diagnostic accuracy of physical examination findings and to construct clinical decision aids to discern emergency department patients without and with midfacial and mandibular fractures that require treatment.
METHODS
A prospective multicentre cohort study was conducted in four hospitals in the Netherlands. Consecutive maxillofacial trauma patients were included whereupon each patient underwent a standardized physical examination consisting of 15 and 14 findings for midfacial and mandibular trauma, respectively. The primary outcome was the decision whether to treat during the emergency department stay or within 24 h of admission. The diagnostic accuracy was calculated for the individual physical examination findings and ensuing clinical decision aids with the focus being on detecting midfacial and mandibular fractures that require active treatment.
RESULTS
A total of 766 midfacial trauma patients were identified of whom 339 (44.3%) had midfacial fractures. Of those, 74 (21.8%) required active treatment. A total of 280 mandibular trauma patients were identified of whom 66 (23.6%) had mandibular fractures. Of those, 37 (56.0%) required active treatment. The decision aid for midfacial trauma consisting of facial depression, epistaxis, ocular movement limitation, palpable step-off, objective malocclusion and tooth mobility or avulsion had a sensitivity of 97.3 (90.7-99.3), a specificity of 38.6 (35.0-42.3), and a negative predictive value of 99.3 (97.3-99.8). The decision aid for mandibular trauma consisting of mouth opening limitation, jaw movement pain, objective malocclusion and tooth mobility or avulsion resulted in a sensitivity of 100.0 (90.6-100.0), a specificity of 39.1 (33.2-45.4), and a negative predictive value of 100.0 (96.1-100.0).
CONCLUSION
The clinical decision aids successfully identified midfacial and mandibular trauma patients requiring active fracture treatment and so may be useful in preventing unnecessary radiological procedures in the future.
TRIAL REGISTRATION
The study was registered at ClinicalTrials.gov with the identifier NCT03314480.
目的
评估体格检查结果的诊断准确性，并构建临床决策辅助工具，以区分需要治疗的急诊科无和有中面部及下颌骨骨折的患者。
方法
在荷兰的 4 家医院进行了一项前瞻性多中心队列研究。连续纳入颌面创伤患者，每位患者均接受标准化体格检查，中面部创伤检查包括 15 项，下颌骨创伤检查包括 14 项。主要结局是在急诊科就诊期间或入院后 24 小时内决定是否进行治疗。针对个别体格检查结果和随后的临床决策辅助工具计算诊断准确性，重点是检测需要积极治疗的中面部和下颌骨骨折。
结果
共确定了 766 例中面部创伤患者，其中 339 例（44.3%）存在中面部骨折。其中，74 例（21.8%）需要积极治疗。共确定了 280 例下颌骨创伤患者，其中 66 例（23.6%）存在下颌骨骨折。其中，37 例（56.0%）需要积极治疗。中面部创伤的决策辅助工具包括面部凹陷、鼻出血、眼球运动受限、可触及台阶、客观咬合不正和牙齿松动或脱位，其敏感性为 97.3%（90.7%-99.3%），特异性为 38.6%（35.0%-42.3%），阴性预测值为 99.3%（97.3%-99.8%）。下颌骨创伤的决策辅助工具包括张口受限、颌骨运动疼痛、客观咬合不正和牙齿松动或脱位，其敏感性为 100.0%（90.6%-100.0%），特异性为 39.1%（33.2%-45.4%），阴性预测值为 100.0%（96.1%-100.0%）。
结论
临床决策辅助工具成功识别了需要积极治疗骨折的中面部和下颌骨创伤患者，因此可能有助于防止未来不必要的影像学检查。
试验注册
该研究在 ClinicalTrials.gov 注册，标识符为 NCT03314480。
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