急性踝关节损伤中使用X线摄影的临床决策规则验证失败。
Failed validation of a clinical decision rule for the use of radiography in acute ankle injury.
作者信息
Kelly A M, Richards D, Kerr L, Grant J, O'Donovan P, Basire K, Graham R
机构信息
Emergency Department Hutt Hospital, Lower Hutt, New Zealand.
出版信息
N Z Med J. 1994 Jul 27;107(982):294-5.
AIM
To validate the Ottawa clinical decision rule for the use of radiography in acute ankle injuries.
METHOD
A prospective, multicentre trial of 350 adult patients presenting with acute ankle injuries consisting of correlation of the features of the Ottawa clinical decision rule with the results of x-rays.
RESULTS
There were 75 fractures in 350 patients, five of which would have been missed by the clinical decision rule. The sensitivity of the rule was 93% with a specificity of 11%. The positive predictive value was 22%, the false negative rate 14%. Fractures that would have been missed by the clinical decision rule included one unstable fracture of the ankle, one fracture of the talus, one calcaneal fracture and one fracture each of the cuboid and navicular.
CONCLUSION
The Ottawa clinical decision rule for the use of radiography in acute ankle injuries is unacceptable for application in emergency departments in New Zealand due to a high false negative rate.
目的
验证渥太华急性踝关节损伤X线检查临床决策规则。
方法
一项针对350例急性踝关节损伤成年患者的前瞻性多中心试验，内容为渥太华临床决策规则的特征与X线检查结果的相关性。
结果
350例患者中有75例骨折，其中5例骨折根据临床决策规则会被漏诊。该规则的敏感性为93%，特异性为11%。阳性预测值为22%，假阴性率为14%。根据临床决策规则会被漏诊的骨折包括1例踝关节不稳定骨折、1例距骨骨折、1例跟骨骨折以及各1例骰骨和舟骨骨折。
结论
由于假阴性率较高，渥太华急性踝关节损伤X线检查临床决策规则不适用于新西兰急诊科。
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