Hartley Rebecca L, Ronksley Paul, Harrop A Robertson, Baykan Altay, Wei Sabrina, Forbes Diana, Arneja Jugpal, Canturk Toros, Cheung Kevin, Fraulin Frankie O G
Department of Surgery and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada.
Faculty of Medicine, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
Plast Surg (Oakv). 2025 Feb;33(1):124-132. doi: 10.1177/22925503231190933. Epub 2023 Aug 7.
The Calgary Kids' Hand Rule (CKHR) is a clinical prediction rule intended to guide referral decisions for pediatric hand fractures presenting to the emergency department, identifying "complex" fractures that require surgical referral and optimizing care through better matching of patients' needs to provider expertise. The objective of this study was to externally validate the CKHR in two different tertiary pediatric hospitals in Canada. We partnered with British Columbia Children's Hospital (BCCH) and the Children's Hospital of Eastern Ontario (CHEO) to externally validate the CKHR using data from retrospective cohorts of pediatric hand fractures (via electronic medical record and x-ray review). Model performance was evaluated at each site using sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and the C-statistic. A total of 954 hand fractures were included in the analysis (524 at BCCH and 430 at CHEO. At BCCH, the CKHR had a sensitivity of 91.1% (133 predicted complex out of 146 total complex fractures), specificity of 71.4% (269 predicted simple out of 377 total simple fractures), and C-statistic of .81, 95% CI [0.78-0.84]. At CHEO, the CKHR had a sensitivity of 98.3%, specificity of 30.2%, and C-statistic of .64, 95% CI [0.61-0.67]. The CKHR performed well at two different tertiary care centres with high sensitivity, supporting its ability to facilitate hand fracture triage in other populations without further modification. This work should be followed by rigorous implementation analysis to determine its impact on patient care.
卡尔加里儿童手部规则（CKHR）是一种临床预测规则，旨在指导急诊科对儿童手部骨折的转诊决策，识别需要手术转诊的“复杂”骨折，并通过更好地将患者需求与医疗服务提供者的专业知识相匹配来优化护理。本研究的目的是在加拿大两家不同的三级儿童医院对CKHR进行外部验证。我们与不列颠哥伦比亚省儿童医院（BCCH）和安大略东部儿童医院（CHEO）合作，使用儿童手部骨折回顾性队列的数据（通过电子病历和X光检查）对CKHR进行外部验证。在每个站点使用敏感性、特异性、阳性似然比、阴性似然比和C统计量评估模型性能。分析共纳入954例手部骨折（BCCH有524例，CHEO有430例）。在BCCH，CKHR的敏感性为91.1%（146例总复杂骨折中有133例预测为复杂骨折），特异性为71.4%（377例总简单骨折中有269例预测为简单骨折），C统计量为0.81，95%CI[0.78 - 0.84]。在CHEO，CKHR的敏感性为98.3%，特异性为30.2%，C统计量为0.64，95%CI[0.61 - 0.67]。CKHR在两个不同的三级护理中心表现良好，具有较高的敏感性，支持其在无需进一步修改的情况下促进其他人群手部骨折分诊的能力。这项工作之后应进行严格的实施分析，以确定其对患者护理的影响。
