Ottawa ankle and foot rules in China: applicability in a defensive environment
Notice bibliographique
Résumé
BACKGROUND: The introduction of any new diagnostic method in a specific clinical setting and culture requires considerable caution, as sensitivity and specificity may be significantly affected. Whether the Ottawa ankle and foot rules (OAFR) are feasible in the Chinese environment is controversial. This study gauges attitudes and calculates the sensitivity and specificity of OAFR in mainland China. METHODS: Short surveys were designed and disseminated to explore the perspective of emergency department trauma doctors and non-medical personnel towards OAFR. We conducted a prospective study at three hospital sites (one-level two hospital and two-level three hospitals) in three provinces. Documentation of OAFR outcomes was recorded in all patients with acute ankle and mid-foot injuries who presented to the three hospitals if they met the inclusion criteria. Anteroposterior and lateral radiographs of the ankle and/or foot were obtained for all patients based on the site of injury. All images were subsequently reviewed by a well-trained radiologist who was blinded to both the OAFR documentation and the emergency physician's interpretation. Radiographic results were compared with fracture prediction based on OAFR to calculate sensitivity and specificity in our patient population. Positive and negative predictive values were also calculated. RESULTS: Only 31.5% of trauma doctors claimed to have heard of OAFR before, and 19.5% of them knew them in detail. 69.5% considered that department leadership in support of a strict interpretation of the rules would assist in their implementation. Both doctors and patients cited potential missed fractures as the dominant concern regarding the application of OAFR. 88.0% of non-medical persons claimed that they could accept the doctor's opinion if made based on these rules. Those with higher educational attainment would be more likely to accept the doctor's opinion. Overall sensitivity was 98.4% and specificity was 26.3%, for detecting fractures in acute ankle and mid-foot injuries. Four fractures out of 602 patients were missed based on OAFR, with one displaced 2nd and 3rd metatarsal fracture resulting in surgery. CONCLUSIONS: OAFR sensitivity in China is as high as in non-Asian populations. Their use is feasible and could be promoted to limit the unnecessary consumption of scare health resources. Survey data suggests implementation could be accepted by most doctors and patients, but would be hampered by the currently fragile doctor-patient relationship.
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 | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| 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 ».