Auleley G R, Ravaud P, Giraudeau B, Kerboull L, Nizard R, Massin P, Garreau de Loubresse C, Vallée C, Durieux P
Délégation à l'Evaluation Médicale-Direction de la Prospective et de l'Information Médicale, Assistance Publique-Hôpitaux de Paris, France.
JAMA. 1997 Jun 25;277(24):1935-9.
To assess the impact of the implementation of the Ottawa ankle rules on radiography requests in French hospitals during a 5-month intervention period and the impact of using posters alone to sustain the effect of the rules during a 5-month postintervention period.
Multicenter randomized controlled trial preceded and followed by observational studies of radiological practices.
The emergency departments of 5 Paris university teaching hospitals of the Assistance Publique-Hôpitaux de Paris.
A total of 2218, 1911, and 851 patients-all aged 18 years and older-who were seen for acute ankle or midfoot injuries in emergency departments during preintervention, intervention, and postintervention periods, respectively.
Implementation of the Ottawa ankle rules by emergency department physicians in the intervention hospitals (using meetings, posters, pocket cards, and data forms). During the postintervention period, posters alone were used to sustain the intervention effect.
Percentage of patients for whom radiography was requested.
During the preintervention period, 98% and 98.5% of patients were referred for radiography in the intervention and control groups, respectively. During the intervention period, the mean proportions of patients referred for radiography by physicians was 78.9% in the intervention group and 99% in the control group (P=.03). Between preintervention and intervention periods, a relative reduction of 22.4% (95% confidence interval [CI], 19.8%-24.9%) in radiography requests was observed in the intervention group, while requests increased by 0.5% (95% CI, 0%-1.4%) in the control group. During the postintervention period, the proportion of radiography requests in the intervention hospitals was lower than the proportion observed in the preintervention period (83.1% vs 98%).
Implementation of the Ottawa ankle rules significantly reduced radiography requests in French hospitals. Using a minimal postintervention implementation strategy, the effect of this intervention decreased but persisted after it was discontinued.
评估渥太华踝关节规则的实施在5个月干预期内对法国医院X线检查申请的影响，以及在5个月的干预后期单独使用海报维持该规则效果的影响。
多中心随机对照试验，试验前后进行放射学实践的观察性研究。
巴黎公共救助医院集团的5家巴黎大学教学医院的急诊科。
分别在干预前、干预期和干预后期因急性踝关节或中足损伤在急诊科就诊的2218例、1911例和851例患者，均为18岁及以上。
干预医院的急诊科医生实施渥太华踝关节规则（通过会议、海报、袖珍卡片和数据表格）。在干预后期，仅使用海报维持干预效果。
申请X线检查的患者百分比。
在干预前期，干预组和对照组分别有98%和98.5%的患者被转诊进行X线检查。在干预期，干预组医生转诊进行X线检查的患者平均比例为78.9%，对照组为99%（P=0.03）。在干预前期和干预期之间，干预组的X线检查申请相对减少了22.4%（95%置信区间[CI]，19.8%-24.9%），而对照组的申请增加了0.5%（95%CI，0%-1.4%）。在干预后期，干预医院的X线检查申请比例低于干预前期观察到的比例（83.1%对98%）。
渥太华踝关节规则的实施显著减少了法国医院的X线检查申请。采用最小化的干预后期实施策略，这种干预的效果在停止后有所下降但仍然存在。
