Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis.
Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis.
复制标题
渥太华踝关节规则排除儿童踝关节和中足骨折的准确性：一项荟萃分析。
DOI：
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发表时间：
2009
影响因子：
4.4
通讯作者：
R. Wright
中科院分区：
文献类型：
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作者：
S. Dowling;C. Spooner;Yuan;D. Dryden;C. Friesen;T. Klassen;R. Wright
目标
目的是进行一项系统评价，以确定渥太华踝关节规则（OAR）排除儿童踝关节和足中段骨折的诊断准确性，以及在不遗漏重大骨折的情况下减少X线使用的程度。
方法
作者对电子数据库和灰色文献来源进行了全面检索。独立评审员采用标准纳入和排除标准。标准诊断测试是踝关节和/或足部X线或替代测量，以确保没有漏诊骨折。构建了标准的2x2表格。使用逆方差近似值合并敏感性和特异性;使用精确方法计算95%置信区间（95% CI）。在DerSimonian和Laird随机效应模型下，将似然比（LR +/-）和诊断优势比合并。
结果
对12项研究（N = 3，130）的汇总分析确定了671例骨折（患病率= 21.4%）。10项研究报告了Salter-Harris I型（SH-I）骨折。合并敏感性为98.5%（95% CI = 97.3 - 99.2），表明OAR可用于排除骨折。10例漏诊骨折中有4例的特征为：1例SH-I，1例SH-IV，2例“无意义骨折”（SH-I或撕脱骨折<3 mm）。X线片减少率的合并估计值为24.8%（95% CI = 23.3%-26.3%;范围= 5%-44%）。
结论
OAR似乎是排除5岁以上儿童踝关节和足中部损伤骨折的可靠工具。使用OAR将显著减少X射线的使用，漏诊骨折的可能性较低。
OBJECTIVES
The objectives were to conduct a systematic review to determine the diagnostic accuracy of the Ottawa Ankle Rules (OAR) to exclude ankle and midfoot fractures in children and the extent to which x-ray use could be reduced without missing significant fractures.
METHODS
The authors conducted comprehensive searches of electronic databases and gray literature sources. Independent reviewers applied standard inclusion and exclusion criteria. The criterion standard diagnostic test was an ankle and/or foot x-ray or proxy measure to ensure no missed fractures. Standard 2 x 2 tables were constructed. Sensitivities and specificities were pooled using an approximation of the inverse variance; 95% confidence intervals (95% CIs) were calculated using the exact method. Likelihood ratios (LR +/-) and diagnostic odds ratios were combined under DerSimonian and Laird random effects model.
RESULTS
A pooled analysis of 12 studies (N = 3,130) identified 671 fractures (prevalence = 21.4%). Ten studies reported Salter-Harris Type I (SH-I) fractures. The pooled sensitivity was 98.5% (95% CI = 97.3 to 99.2), suggesting that the OAR can be used to rule out a fracture. Four of 10 missed fractures were characterized: 1 SH-I, 1 SH-IV, and 2 "insignificant fractures" (either SH-I or avulsion fractures <3 mm). The pooled estimate for rate of x-ray reduction was 24.8% (95% CI = 23.3% to 26.3%; range = 5% to 44%).
CONCLUSIONS
The OAR appear to be a reliable tool to exclude fractures in children greater than 5 years of age presenting with ankle and midfoot injuries. Employing the OAR would significantly decrease x-ray use with a low likelihood of missing a fracture.