Utilidad de las reglas de Ottawa para el tobillo y el medio pie en Atención Primaria (II): análisis económico
Bibliographic record
Abstract
Demostrar la capacidad de las reglas de Ottawa (RO) en el tobillo y el medio pie en Atención Primaria para reducir el número de radiografías innecesarias y estimar, haciendo una proyección de resultados, el ahorro económico que de su implementación se deriva. Estudio descriptivo y transversal sobre el que se realiza una estimación prospectiva de los costes en una muestra de un centro de salud de ámbito urbano. Se seleccionó de forma consecutiva a 72 pacientes desde el 1 de diciembre de 2013 hasta el 30 de abril de 2014 con lesión traumática aguda del tobillo o del medio pie, que cumplían los criterios de inclusión. Se aplicaron las RO y se realizaron radiografías independientemente del resultado. Se calculó el ahorro de costes totales atendiendo al número de radiografías innecesarias y al tiempo de asistencia empleado que hubiera sido evitado, y el ahorro medio por episodio y paciente. En el tiempo de estudio se obtuvo un ahorro de 1.290 € y 16 h de tiempo de atención evitables (en un año 8.690 € y 110 h) y, extrapolando los datos a la Comunidad Autónoma Canaria, se obtendría un ahorro neto de 55.7661 € y 7.054 h evitables. Las RO resultan útiles para seleccionar pacientes con esta dolencia que no necesitan estudio radiográfico, lo que supone un 68 % de radiografías evitables, con el consiguiente ahorro económico que ello supone. To demonstrate the ability of the Ottawa Ankle Rules (OAR) for Ankle and Mid Foot trauma in lowering the number of unnecessary radiographs in Primary Care and make a projection of the economic savings after implementation. A descriptive and cross-sectional study was conducted in which a prospective estimate of the costs was carried out on a sample of 72 patients with ankle and middle foot traumas who met the inclusion criteria, and enrolled consecutively in a Primary Care setting from 1 December 2013 to 30 April 2014. The OAR was applied and X-rays taken on all patients regardless of the outcomes. Total cost savings were calculated according to the number of avoidable X-rays, time of attendance, and the mean economic savings per episode per patient. In the time period of the study, a financial saving of €1,290 was obtained, and 16 hours were saved. Over a period of one year, the savings were €8,690 and 110 hours were saved, and extrapolating the data to the Autonomous Community of Canarias a net saving of €557,661 and 7,054 hours would be achieved. OARs are valid and useful in Primary Care to select patients with Acute Ankle Trauma (AAT) and Acute MidFoot Trauma (AMFT) who do not need radiographs, which would assume a reduction of 68% in avoidable X-rays, with the resulting economic savings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.058 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.005 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.005 | 0.002 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".