基于EMS临床医生的观察,PECARN椎损伤预测规则的性能
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.
儿科紧急护理应用研究网络 (PECARN) 的椎损伤 (CSI) 规则准确地识别了形伤害的儿童. 在紧急医疗服务 (EMS) 中应用这一规则可以减少不必要的脊柱运动限制.
科学领域:
- 紧急医疗
- 儿童创伤
- 临床决策规则
背景情况:
- 儿童椎损伤 (CSI) 存在重大风险.
- PECARN CSI预测规则有助于评估ED中的儿童突击创伤患者.
- 本研究使用医院前紧急医疗服务 (EMS) 临床医生的观察来评估规则的性能.
研究的目的:
- 评估PECARN CSI预测规则的准确性
- 根据EMS临床医生的观察,评估该规则的效果.
- 确定对脊柱运动限制 (SMR) 实践的潜在影响.
主要方法:
- 一项多中心前性观察性研究,涉及18岁以下受伤的儿童.
- 根据他们的观察,EMS临床医生填写了病例报告表,详细说明了CSI风险因素.
- 使用EMS数据评估PECARN CSI预测规则的表现,其中CSI是主要结果.
主要成果:
- 使用EMS数据,PECARN CSI规则显示灵敏度为88.5%和特异性为63.1%.
- 负预测值高达99.7%,表明有效识别没有CSI的儿童.
- 应用该规则可以将SMR从41.5%降至37.7%,而长板使用率则从17.0%降至9.8%.
结论:
- 根据EMS的观察结果,PECARN CSI预测规则在儿童突击创伤患者中具有很好的准确性.
- 在EMS设置中实施该规则可能会减少SMR和长板的使用.
- 这支持PECARN规则在医院前环境中优化儿童创伤护理的实用性.
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