Validation of the Sonographic Ottawa Foot and Ankle Rules (SOFAR) Study in a Large Urban Trauma Center.
Notice bibliographique
Résumé
INTRODUCTION: Differentiating the severity of acute ankle injuries is a common problem in the emergency department (ED). The Ottawa Foot and Ankle Rules (OFAR) were designed to obviate the need for unnecessary x-rays. Although these rules have been determined to be very sensitive, they lack the specificity necessary to make them practically useful for a condition in which a misdiagnosis could result in a significant disability. Our study objective was to determine if the addition of a bedside ultrasound (US) to the evaluation process could be used to significantly reduce the number of negative x-rays in OFAR positive patients. METHODS: A prospective observational studywas conducted in a Level I urban trauma center over a 12 month period in which bedside US was utilized to detect foot and/or ankle fractures in OFAR positive patients of age 18 years and older. All patients in the study received foot and/or ankle x-rays based on OFAR exam. Prior to viewing the x-rays, trained clinicians performed bedside US targeting the medial and lateral malleoli, navicular, and base of the 5th metatarsal and provided a diagnostic impression based on their US findings. The US findings were then compared to the formal x-ray interpretation. RESULTS: A total of fifty patients was enrolled into the study of which twenty-one patients were discovered to have a fracture by US. The sensitivity ofUS in detecting foot and/or ankle fractures was 100% (95% Confidence Interval [CI] 78%-100%) and the specificity of OFAR increased from 50% (95% CI 37%-63%) to 100% (95% CI 87%-100%) with the addition of US. The negative predictive value was 100% (95% CI 89%-100%), and the positive predictive value was 100% (95% CI 81%-100%). CONCLUSIONS: Among OFAR positive patients, bedside US has high sensitivity and specificity for detecting foot and/or ankle fractures. Further studies should be conducted to determine if utilizing bedside US in addition to OFAR could significantly reduce the number of x-rays and improve the efficiency and costs associated with evaluating these injuries in the ED. Implication for health policy/medical education/research/ practice. Utilizing bedside ultrasonography in addition to Ottawa Foot and Ankle Rules in acutely injured patients could significantly reduce the number of ordered x-rays and length of stay in the emergency department.
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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 | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 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 ».