Shoulder Dislocation In Ontario, Canada From 1994 To 2011: The Incidence, Rate And Risk Factors For Recurrence
Notice bibliographique
Résumé
Objectives: Recurrent shoulder dislocation is influenced by age, activity level and bone loss. Original estimates of recurrence risk approached 90% among persons under the age of 20, but declined with increasing age. Recent literature, however, suggests that the rate of recurrent dislocation is lower. The goals of this study were to: (1) define the incidence of primary shoulder dislocation in Ontario, Canada, and (2) identify the rate of and risk factors for recurrent dislocation among demographic variables. Methods: Administrative databases (OHIP) were used to build the cohort of patients aged 15 to 70 that underwent a primary closed shoulder reduction by a physician in Ontario between July 1994 and October 2009. Exclusions included: associated humeral neck fracture, posterior dislocation, previous shoulder dislocation, prior shoulder arthroplasty, and non-Ontario residents. After cohort entry, subsequent shoulder relocations by a physician were sought. The yearly incidence (per 100,000 person-years) was calculated among all eligible Ontario residents. Kaplan-Meier survival curves to subsequent dislocation were generated. A Prentice, Williams and Peterson conditional proportional hazards survivorship model of time-to-recurrence was applied examining the influence of age, gender, income quintile, physician specialty and concurrent tuberosity fracture at index dislocation on the risk of recurrence (alpha set at 0.05). Hazard Ratios (HR) with confidence intervals were calculated. Results: The primary dislocation cohort consisted of 37,356 patients. Median age was 34 years (IQR 22-50) and 74% were male. The average yearly incidence of primary shoulder dislocation was 23.1/100,000 person-years overall, but 45.2/100,000 person-years for patients younger than 20. Recurrent dislocation events were identified in 23% of the cohort (8573 patients), most of whom were younger (median age 24 years) and male (80%). In fact, patients younger than 20 had a 37.8% rate of recurrence (HR 1.9 (1.7-2.1), p<0.0001; compared to patient aged 36-40). Kaplan-Meier survival curves showed most recurrent dislocations took place in the first year: 93.4% at 6-months, 89.4% at 1-year, 85.2% at 2-years and 79.4% at 5-years. Protective factors against recurrence included primary relocation performed by an Orthopaedic Surgeon (HR 0.87 (0.79-0.94), p=0.001), age over 50 years (5.5% rate; HR 0.70 (0.61-0.80, p<0.0001) and an associated tuberosity fracture (HR 0.51 (0.42-0.63), p<0.0001), while lowest income quintile was a risk factor for recurrence (HR 1.1 (1.04-1.16), p=0.0007). Interestingly, at 2.5 years from the primary dislocation, only 14.7% of the cohort had undergone surgical shoulder stabilization. Conclusion: Patients under 20 had twice the incidence of primary dislocation and twice the risk of recurrent shoulder dislocation compared to the median cohort age. A recurrence rate of 38% in patients under 20 is high, but less than previous reports.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,005 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».