减少上肢或下肢受伤儿童成像干预措施:系统性审查和元分析
Scott William Kirkland1, Nick Lesyk1, Erika Herle1
1Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
Emergency medicine journal : EMJ
|December 24, 2025
概括
儿科四肢损伤的临床决策规则有效地减少了急诊室 (ED) 的放射. 虽然对脚受伤有好处,但由于潜在的错过诊断,建议对手腕受伤保持谨慎.
科学领域:
- 儿科急救医学 儿科急救医学
- 放射学决策支持 放射学决定支持
背景情况:
- 在儿童中不必要的成像引起了人们对辐射暴露,成本和延迟的担忧.
- 临床决策规则 (CDR) 正在开发中,以优化儿科紧急护理中的成像实践.
研究的目的:
- 系统地审查旨在减少急诊部上肢或下肢受伤的儿童的放射性干预措施.
主要方法:
- 在7个数据库和灰色文献中进行了系统的搜索,直到2024年5月.
- 包括的研究是比较和评估的干预措施,以减少儿科肢体成像在ED.
- 用随机效应模型提取和分析数据,以确定成像率的变化.
主要成果:
- 包括8项涉及7793名儿童的研究,其中大多数使用了前后设计.
- 脚损伤CDR显著减少了X射线 (OR=0.11),手腕损伤CDR也减少了成像 (OR=0.06),但错过了8起伤害.
- 临床指导方针减少了每名患者的X射线图,而使用CDR的一次分拣护士干预增加了成像,并错过了16名受伤者.
结论:
- 结合CDR的指导方针,特别是在脚损伤方面,可以减少ED中儿科四肢损伤的X光学.
- 需要进一步的研究来确定其他四肢损伤的有效干预措施,并优化临床医生的向.
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