University College London, UK.
Royal Free London NHS Foundation Trust, UK.
Ann R Coll Surg Engl. 2023 Nov;105(8):685-691. doi: 10.1308/rcsann.2022.0152. Epub 2023 Mar 16.
Electronic pathways (e-pathways) and digital systems are novel interventions with several uses in healthcare, ranging from clinical decision support systems to checklists for care delivery. Their application in the management of neck of femur (NOF) fractures is evolving and they may play a key role in facilitating improvements in care delivery. The primary aim of this review was to outline the impact of e-pathways/digital systems on NOF fracture outcomes.
A systematic literature search was performed using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. A total of 698 citations were evaluated, of which 38 passed the inclusion/exclusion criteria. Six studies were then finalised following full-text review. Heterogenous data meant a narrative synthesis was undertaken. Risk of bias for each paper was assessed using the Downs and Black scale.
A statistically significant improvement was demonstrated for time to theatre (3/6 studies), length of hospital stay (2/6 studies) and secondary fracture prevention (2/6 studies). Although postoperative delirium and mortality improved with the introduction of e-pathways/digital systems, statistical significance was not achieved. No outcome measures were adversely affected.
This systematic review of the literature demonstrates that e-pathways and digital systems are promising novel interventions, displaying a significant positive impact on several NOF fracture outcomes. Owing to the novel nature of e-pathways and digital systems in orthopaedics, a limited number of studies were identified for review, each with variable study design. More high quality homogenous prospective cohort studies with a standardised primary outcome measure are required for more definitive conclusions of efficacy to be drawn.
电子路径（e-pathways）和数字系统是新颖的干预措施，在医疗保健中有多种用途，从临床决策支持系统到护理交付清单不等。它们在管理股骨颈（NOF）骨折中的应用正在不断发展，并且可能在促进护理交付的改进方面发挥关键作用。本综述的主要目的是概述电子路径/数字系统对 NOF 骨折结果的影响。
按照 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行系统文献检索。评估了 698 条引文，其中 38 条符合纳入/排除标准。然后，在进行全文审查后，最终确定了 6 项研究。由于数据存在异质性，因此进行了叙述性综合分析。使用唐斯和布莱克量表评估每篇论文的偏倚风险。
有 3/6 项研究显示手术时间、住院时间和继发性骨折预防方面有统计学意义的改善。尽管引入电子路径/数字系统后术后谵妄和死亡率有所改善，但未达到统计学意义。没有观察到任何不良的结局。
对文献的系统回顾表明，电子路径和数字系统是有前途的新颖干预措施，对几种股骨颈骨折结果显示出显著的积极影响。由于电子路径和数字系统在骨科中的新颖性，仅确定了数量有限的研究进行综述，每项研究的设计都存在差异。需要更多高质量的同质前瞻性队列研究，并采用标准化的主要结局指标，才能得出更明确的疗效结论。
