Lucchesi G M, Jackson R E, Peacock W F, Cerasani C, Swor R A
Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA.
Ann Emerg Med. 1995 Jul;26(1):1-5. doi: 10.1016/s0196-0644(95)70229-6.
To validate criteria predicting ankle and mid-foot fractures with 100% sensitivity.
Prospective validation study
A 929-bed community teaching hospital with an annual census of 76,488 ED visits.
Convenience sample of patients older than 18 years with acute ankle or midfoot injury.
Radiography was performed in each patient received after pertinent history and physical examination findings were recorded.
Five hundred seventy radiographs were obtained in 484 patients. Four hundred twenty-one were of the ankle, and 149 were of the foot. There were 93 ankle fractures and 29 midfoot fractures, giving a fracture yield of 22.1% for ankle films and 19.5% for foot films. Decision rules had sensitivity of 94.6% and specificity of 15.5% for ankle fractures and sensitivity of 93.1% and specificity of 11.5% for midfoot fractures. Prospective criteria failed to predict fracture in five of the ankle group and two of the midfoot group. Physicians predicting fracture solely on the basis of clinical suspicion had a sensitivity of 69% in ankle injuries and 76% in midfoot injuries.
We were unable to validate with 100% sensitivity the Ottawa rules predicting ankle and midfoot fractures. However, the Ottawa rules were more sensitive than clinical suspicion alone.
验证预测踝关节和中足骨折且敏感度达100%的标准。
前瞻性验证研究
一家拥有929张床位的社区教学医院，年急诊就诊量为76488人次。
年龄大于18岁的急性踝关节或中足损伤患者的便利样本。
在记录每位患者的相关病史和体格检查结果后进行X线摄影。
484例患者共获得570张X线片。其中踝关节X线片421张，足部X线片149张。踝关节骨折93例，中足骨折29例，踝关节X线片骨折检出率为22.1%，足部X线片骨折检出率为19.5%。诊断标准对踝关节骨折的敏感度为94.6%，特异度为15.5%；对中足骨折的敏感度为93.1%，特异度为11.5%。前瞻性标准未能预测出踝关节组中的5例骨折和中足组中的2例骨折。仅基于临床怀疑来预测骨折的医生，对踝关节损伤的敏感度为69%，对中足损伤的敏感度为76%。
我们未能验证预测踝关节和中足骨折的渥太华规则的敏感度达100%。然而，渥太华规则比单纯的临床怀疑更具敏感性。
