RESUMO
To assess the potential for selective use of roentgenography in evaluating extremity injuries, prediction rules were developed based on prospective observations for 617 injured children and adolescents examined in our Emergency Department (phase 1) and tested on 601 examined 1 year later (phase 2). Logit analysis produced best-fitting statistical models for phase 1 data with significant (P less than 0.05) direct effects of gross signs, point tenderness, activity not routine, swelling moderate or severe, time from injury less than 6 hours, and pain with motion for upper extremity injuries; and, for lower extremity injuries, not knee injury, activity not routine, point tenderness, and foot injury. Prediction rules developed in phase 1 performed equally well when tested on phase 2 injuries. Data from both phases were combined, therefore, in analysis that produced risk estimates. For all injury types (ie, for injuries with all possible combinations of presence or absence of these findings), risk for fracture was derived. For upper extremity injuries, with a threshold risk for fracture of 20% used to select specific injury types for roentgenography, prediction rule outcomes were 18.1% of roentgenograms avoided and 5.3% of fractures missed. For lower extremity injuries, using a threshold risk of 10% to select injury types for roentgenography, outcomes were 25.8% of roentgenograms avoided and 5.3% of fractures missed. Alternative prediction rules allowed still greater roentgenogram avoidance, although missed fractures also increased. Risk of adverse functional outcome from missed fractures appeared small. Annual national cost savings from the elimination of 18.1% of upper and 25.8% of lower extremity roentgenographic evaluations was estimated at $103 million.
Assuntos
Traumatismos do Braço/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Traumatismos da Perna/diagnóstico por imagem , Adolescente , Traumatismos do Braço/economia , Traumatismos do Braço/epidemiologia , Criança , Custos e Análise de Custo/economia , Emergências , Feminino , Fraturas Ósseas/economia , Fraturas Ósseas/epidemiologia , Humanos , Traumatismos da Perna/economia , Traumatismos da Perna/epidemiologia , Modelos Logísticos , Masculino , Análise Multivariada , New York/epidemiologia , Probabilidade , Prognóstico , Radiografia , Fatores de RiscoRESUMO
Central acetabular fracture-dislocations resulting from convulsions are rare. The literature is reviewed in this regard and we add two additional cases in which hyponatremia was the cause of seizure activity. In most cases this type of injury is seen in bone already weakened by underlying disease.