Seaberg D C, Jackson R
Department of Emergency Medicine, Mercy Hospital of Pittsburgh, PA 15219.
Am J Emerg Med. 1994 Sep;12(5):541-3. doi: 10.1016/0735-6757(94)90274-7.
The objective of this study was to develop a decision rule for ordering x-rays in knee injuries. Phase I was a retrospective chart review of 201 consecutive patients receiving knee radiographs in the emergency department in a 10-month period. Logistic regression was performed on 11 clinical indicators to develop a clinical decision rule. Phase II was a prospective validation study on 133 consecutive patients with knee injuries. All patients received radiographs to validate the decision rule. Sensitivity, specificity, and misclassification rate were calculated. Logistic regression analysis found that a fall or blunt trauma mechanism yielded a logistic regression sensitivity of 92%, specificity of 57%, with a false-negative rate of 0.9%. The addition of inability to ambulate and age (younger than 12 or older than 50 years of age) yielded a sensitivity of 92% with a specificity of 63%. The prospective study found the combination of fall or blunt trauma with either inability to ambulate or age (younger than 12 to older than 50 years of age) was 100% sensitive, with a specificity of 79%. The misclassification rate was 20%. Using this decision rule, the number of x-rays taken could have been reduced by 78%. A larger multicenter validation study of this knee radiograph decision rule is needed before widespread clinical usage.
本研究的目的是制定一项针对膝关节损伤进行X光检查的决策规则。第一阶段是对在10个月期间急诊科接受膝关节X光检查的201例连续患者进行回顾性病历审查。对11项临床指标进行逻辑回归分析，以制定临床决策规则。第二阶段是对133例连续膝关节损伤患者进行前瞻性验证研究。所有患者均接受X光检查以验证该决策规则。计算敏感性、特异性和错误分类率。逻辑回归分析发现，跌倒或钝性创伤机制的逻辑回归敏感性为92%，特异性为57%，假阴性率为0.9%。加上无法行走和年龄（12岁以下或50岁以上），敏感性为92%，特异性为63%。前瞻性研究发现，跌倒或钝性创伤与无法行走或年龄（12岁以下至50岁以上）相结合的敏感性为100%，特异性为79%。错误分类率为20%。使用该决策规则，X光检查的数量可减少78%。在广泛临床应用之前，需要对该膝关节X光检查决策规则进行更大规模的多中心验证研究。
