EMSの臨床医の観察に基づいたPECARN頸椎損傷予測規則の性能
Lorin R Browne1, Caleb E Ward, Monica Harding
1From the Departments of Pediatrics and Emergency Medicine (L.R.B.), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Pediatrics (C.E.W.), The George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, District of Columbia; EMSC Data Center (M.H.), University of Utah School of Medicine; Department of Pediatrics (L.J.C.), University of Utah School of Medicine, Salt Lake City, Utah; Department of Pediatrics (K.M.A.), University of Colorado School of Medicine, Aurora, Colorado; Department of Pediatrics (F.A.A.), Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri; Department of Emergency Medicine (R.B.), Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics (P.P.C.), Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics (D.J.C.), Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics (N.W.G.), University of California, Benioff Children's Hospital, Oakland; Department of Pediatrics (N.K.), University of California, Davis School of Medicine, Sacramento, California; Department of Pediatrics (L.K.L.), Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts; Department of Neurologic Surgery (J.R.L.), Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Emergency Medicine (S.O.-A.), University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics (L.C.R.), University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Emergency Medicine (A.J.R.), University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Pediatrics (D.M.R.), Baylor College of Medicine, Texas Children's Hospital, Houston, Texas; Department of Emergency Medicine (R.E.S.), University of New Mexico Health Sciences Center, Albuquerque, New Mexico; Department of Pediatrics (M.A.S.), University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah; Department of Emergency Medicine (L.T.), University of California, Davis School of Medicine, Sacramento, California; Department of Pediatrics (K.Y.), Children's Health Dallas, University of Texas Southwestern Medical Center, Dallas, Texas; and Department of Pediatrics (J.C.L.), Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio.
小児緊急医療応用研究ネットワーク (PECARN) の頸椎損傷 (CSI) 規則は,鈍い傷を負った子どもを正確に特定します. 緊急医療サービス (EMS) でこのルールを適用すると,不必要な脊髄運動の制限を減らすことができます.
科学分野:
- 緊急 医療
- 小児 トラウマ
- 臨床決定のルール
背景:
- 子宮頸椎損傷 (CSI) は大きなリスクが伴う.
- PECARN CSI 予測ルールは,EDで小児の突撃トラウマ患者の評価に役立ちます.
- この研究では,病院前の緊急医療サービス (EMS) の臨床医の観察を用いてルールのパフォーマンスを評価しています.
研究 の 目的:
- PECARN CSI予測ルールの精度を評価する.
- EMSの臨床医の観察に基づいた規則のパフォーマンスを評価する.
- 脊髄運動制限 (SMR) への潜在的な影響を決定する.
主な方法:
- 18歳未満の子どもを対象とした多センター展望観察研究
- EMSの臨床医は,彼らの観察に基づいてCSIの危険因子を詳細に記載した症例報告フォームを記入しました.
- PECARN CSI予測規則のパフォーマンスは,EMSデータを使用して評価され,CSIが主なアウトカムでした.
主要な成果:
- PECARN CSIルールは,EMSデータを用いて88. 5%の感度と63. 1%の特異性を示した.
- 陰性予測値は99. 7%で高く,CSIのない子供の有効な識別を示した.
- このルールを適用すると,SMRは41.5%から37.7%に,ロングボードの使用は17.0%から9.8%に低下する可能性がある.
結論:
- PECARN CSI予測ルールは,EMSの観察に基づいて小児の鈍いトラウマ患者のCSIを特定するのに高い精度を示しています.
- EMSの設定でルールを適用すると,SMRとロングボードの両方の使用が減少する可能性があります.
- これは,小児のトラウマケアを最適化するために,病院前でのPECARN規則の有用性を支持しています.
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