Anterior cruciate ligament injury: A persistently difficult diagnosis
Anterior cruciate ligament injury: A persistently difficult diagnosis
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DOI：
10.1016/j.knee.2015.09.016
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发表时间：
2016-01-01
期刊：
影响因子：
1.9
通讯作者：
Servant, Christopher
中科院分区：
文献类型：
--
作者：
Parwaiz, Hammad;Teo, Alex Q. A.;Servant, Christopher
背景：历史上前交叉韧带（ACL）损伤诊断不佳。1996年发表在《损伤》（Injury）杂志上的一篇论文显示，只有不到10%的前交叉韧带损伤患者的诊断是由第一个为他们看病的医生做出的，从首次出现到诊断的平均延迟时间为21个月。我们研究的目的是调查在过去的二十年中，前交叉韧带损伤的诊断是否有了进步。方法：我们确定了2004年10月至2011年12月间由一名外科医生进行ACL重建的160例患者，他们的完整数据集是可用的。数据回顾性地从医院记录和专门的患者数据库中提取。我们进行了亚组分析，比较2007年4月引入急性膝关节损伤诊所之前的患者和引入诊所后的患者。结果：75.1%（120/160）的患者首先就诊于急诊科（ED）或全科医生（GP），但只有14.4%（23/160）的患者在初次就诊时得到诊断。在诊断ACL损伤之前，患者看到的医疗保健专业人员的中位数为3。从损伤到出现的中位延迟为0周（范围0-885），损伤到诊断的中位延迟为13周（0-926），出现到诊断的中位延迟为10周（0-924），出现到专科膝关节门诊的中位延迟为24周（0-1006），专科膝关节门诊到手术的中位延迟为13周（0-102）。从受伤到手术的中位总时间为42周（0-1047）。在2007年实施急性膝关节损伤门诊后，从发病到手术的中位延迟从59周下降到36周（p= 0.050），从专科膝关节门诊到手术的中位延迟从23周显著下降到11周（p=0.002）。结论：在过去的二十年中，前交叉韧带损伤的早期诊断似乎没有什么改善，只有14.4%的患者在初次就诊时被正确诊断。我们建议对急诊和初级保健临床医生进行进一步的前交叉韧带损伤诊断教育，强调前交叉韧带损伤典型病史的重要性。急性膝关节损伤门诊的实施可能有助于最大限度地减少手术延误，这应该导致更好的患者预后。(C) 2015 Elsevier B.V.版权所有
Background: Historically anterior cruciate ligament (ACL) injuries have been diagnosed poorly. A paper published in Injury in 1996 showed that less than 10% of patients with an ACL injury had the diagnosis made by the first physician to see them and that the average delay from first presentation to diagnosis was 21 months. The aim of our study was to investigate whether an improvement has been made over the last two decades in diagnosing ACL injuries.Methods: We identified 160 patients who had an ACL reconstruction performed by a single surgeon between October 2004 and December 2011 and for whom a complete data set was available. Data was extracted retrospectively from the hospital notes and a dedicated patient database. We performed a sub-group analysis comparing patients seen prior to the introduction of an acute knee injury clinic in April 2007 and patients seen after the introduction of the clinic.Results: 75.1% (120/160) of patients presented first to an emergency department (ED) or to their general practitioner (GP), but only 14.4% (23/160) were diagnosed on initial presentation. The median number of healthcare professionals a patient saw prior to a diagnosis of ACL injury was 3. The median delay from injury to presentation was 0 weeks (range 0-885), injury to diagnosis 13 weeks (0-926), presentation to diagnosis 10 weeks (0-924), presentation to a specialist knee clinic 24 weeks (0-1006), and specialist knee clinic to surgery 13 weeks (0-102). The median total time from injury to surgery was 42 weeks (0-1047). Following the implementation of an acute knee injury clinic in 2007, the median delay from presentation to surgery dropped from 59 weeks to 36 weeks (p = 0.050) and there was a significant decrease in the median delay from specialist knee clinic to surgery from 23 to 11 weeks (p=0.002).Conclusion: Over the past two decades there appears to have been little improvement in the early diagnosis of ACL injuries, with only 14.4% of patients being diagnosed correctly at initial presentation. We recommend further education of emergency and primary care clinicians in the diagnosis of ACL injuries, emphasising the importance of the typical history of an ACL injury. The implementation of an acute knee injury clinic may help minimise delays to surgery, which should result in better patient outcomes. (C) 2015 Elsevier B.V. All rights reserved.