Notice bibliographique
Résumé
Source:Boutis K, Komar L, Jaramillo D, et al. Sensitivity of a clinical examination to predict need for radiography in children with ankle injuries: a prospective study. Lancet. 2001;358:2118–2121.Radiographs are frequently ordered for children presenting with an ankle injury. Investigators from Boston and Toronto assessed the predictive value of the clinical examination to de. ne a low-risk group whose management would not be affected by the absence of a radiograph. They hypothesized that no more than 1% of children with low-risk exams (de. ned as pain and/or tenderness with or without edema or ecchymoses restricted to the distal fibula, the 3 adjacent ligaments, or both) would have fractures at risk of complications. (Potentially uncomplicated fractures included all except avulsion, buckle, and non-displaced Salter-Harris I and II fractures of distal fibula). They also compared the accuracy of their low-risk criteria with the Ottawa ankle rules (radiographs required only if there is pain near the malleoli accompanied by 1 or more of the following: inability to bear weight; bone tenderness at the posterior edge; or bone tenderness at the tip of either malleolus).1Clinical examinations and subsequent radiographs were prospectively and independently evaluated in 2 pediatric emergency departments among healthy 3- to 16-year-old children with acute ankle injuries. Of 607 enrolled children, 381 had low-risk and 226 had high-risk clinical examinations. None of the 381 children with low-risk examinations had a high-risk fracture (negative predictive value 100%; 95% CI, 99.2-100). Of 226 children with high-risk clinical examinations, 45 had a signi. cant fracture (positive predictive value 20%; 95% CI, 14.9-25.7). Using the proposed low-risk criteria, the ankle examination has a sensitivity of 100% (95% CI, 93.3-100) and a speci. city of 68%. If these criteria were applied, radiographs could be omitted in 63% of children with ankle injuries compared to a 12% reduction using the Ottawa ankle rules.This study shows that a clinical exam can successfully predict which children can avoid radiography following ankle trauma. Their exam criteria are simpler than the previously described Ottawa ankle rules1 and were more effective in reducing the number of radiographs. The investigators point out that their findings may not apply to clinicians with less training and experience in the clinical examination of children’s ankles. Most pediatricians should be able to apply this test and avoid unnecessary ankle x-rays.It is important to recognize that a low-risk examination using the proposed criteria does not rule out an ankle fracture, but it does provide assurance that if a fracture is present it is unlikely to be unstable or at risk for complications. There remains some controversy about how best to manage this low-risk group, but all would agree that close follow-up is essential.
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 distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 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 tête enseignante, 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 ».