A study to develop clinical decision rules for the use of radiography in acute ankle injuries

Stiell, Ian G.; Greenberg, Gary H.; McKnight, R. Douglas; Nair, Rama C.; McDowell, Ian; Worthington, James

doi:10.1016/s0196-0644(05)82656-3

Cited by 559 publications

(317 citation statements)

References 28 publications

Supporting

Mentioning

299

Contrasting

Unclassified

Order By: Relevance

“…These methods have been used in other high calibre decision rule studies. [32][33][34][35] Our study also has potential limitations. The outcome "urological intervention" can vary among urologists in different geographic areas and may be influenced by independent patient factors such as associated ureteral pathology, patient occupation and patient preference.…”

Section: Discussionmentioning

confidence: 92%

Predicting intervention in renal colic patients after emergency department evaluation

Papa

Stiell

Wells

et al. 2005

CJEM

View full text Add to dashboard Cite

Objectives:There is no set of prospectively validated criteria to identify the emergency department (ED) patients with renal colic who are most likely to eventually have to undergo an intervention. This study prospectively assessed predictors of intervention in this patient population. Methods: This prospective cohort study included adult patients with renal colic who presented to 2 tertiary care hospital EDs. Patients had an 18-variable data form completed by an emergency physician and a radiological study to confirm urolithiasis. After discharge, patients were followed at 1 and 4 weeks to assess for intervention. The outcome criteria included the patient having had at least 1 of the following procedures performed: extracorporeal shockwave lithotripsy (ESWL), ureteroscopy, percutaneous nephrostomy or open surgery. Data were analyzed using appropriate univariate techniques, and those variables associated with intervention were combined using logistic regression analysis. Results: Over an 8-month period, 245 patients with confirmed urolithiasis were followed; 20% (95% confidence interval [CI] 15%-25%) eventually had a procedure to remove their calculi. Three variables were significantly correlated with having a procedure: i) size of calculus ≥ 6 mm (odds ratio [OR] 10.7, 95% CI 4.6-24.8), ii) location of calculus above mid-ureter (OR 6.9, 95% CI 3.0-15.9), and iii) Visual Analogue Scale score for pain at discharge from the ED ≥ 2 cm (OR 2.6, 95% CI 1.0-6.8). The area under receiver operating characteristic curve was 0.77 (95% C I 0.70-0.84) (p < 0.001). If all variables were present there was a 90% probability of the patient having an intervention performed within 4 weeks of discharge from the ED. Conversely, if none of the variables were present there was only a 4% probability of an intervention. Overall, the model had a sensitivity of 92% (95% CI 89%-96%) and a specificity of 63% (95% CI 57%-69%). Conclusions: This study has identified variables that could potentially be used to identify those renal colic patients who require an intervention after ED evaluation. Future studies will prospectively validate this model. RÉSUMÉObjectifs : Il n'existe pas d'ensemble de critères validés prospectivement pour identifier les patients reçus au département d'urgence pour une colique néphrétique qui sont les plus susceptibles EM ADVANCES • INNOVATIONS EN MU

show abstract

Section: Discussionmentioning

confidence: 92%

Predicting intervention in renal colic patients after emergency department evaluation

Papa

Stiell

Wells

et al. 2005

CJEM

View full text Add to dashboard Cite

show abstract

“…Timely diagnosis, treatment and nursing care are very important for the reduction of pain and the healing of fractures. The Ottawa Ankle Rules (OAR) (34)(35)(36) that were developed by Ottawa emergency physicians were adopted to assist in determining if radiography should be used to determine whether radiography would be appropriate to diagnose ankle fracture in a patient experiencing ankle pain. It has been demonstrated that when pediatric emergency department (ED) nurses accurately apply and interpret OAR, children in the hospital ED were treated with a nursing collaborative practice protocol (CPP) to minimize throughput time and expedite patient care (37).…”

Section: Discussionmentioning

confidence: 99%

N‑methyl pyrrolidone promotes ankle fracture healing by inhibiting inflammation via suppression of the mitogen‑activated protein kinase signaling pathway

et al. 2018

View full text Add to dashboard Cite

Abstract. N-methyl pyrrolidone (NMP), a small bioactive molecule, has the potential to stimulate bone formation and inhibit osteoclast differentiation. The aim of the present study was to investigate the effect of NMP on the inflammatory response and underlying molecular mechanisms in MG-63 cells. The mRNA and protein expression of cytokines from peripheral blood in children with or without ankle fracture were determined by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and ELISA, respectively. MG-63 cells were pre-treated with/without NMP and stimulated with 1 µM bradykinin (BK). The production of cytokines from MG-63 cells was assessed by western blotting and RT-qPCR. The expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) mRNA and protein were measured using western blotting and/or RT-qPCR. Western blotting was used to examine the activation level of mitogen activated protein kinase. Compared with healthy children, levels of tumor necrosis factor (TNF-α), interleukin (IL)-1β and IL-6 mRNA and protein were upregulated in children with ankle fracture. NMP treatment did not induce cytotoxicity in MG-63 cells. The BK-induced upregulation of TNF-α, IL-1β, IL-6, iNOS and COX-2 mRNA and protein was reversed in a dose-dependent manner by NMP. Furthermore, NMP downregulated the activation of c-Jun NH2-terminal kinase and p38 pathways, but not the extracellular signal-related kinase pathway. Therefore, the results of the current study demonstrate that NMP inhibits inflammation dependent on the mitogen-activated protein kinase pathway in MG-63 cells, indicating that it may be beneficial in the healing of fractures.

show abstract

“…RP involves the sequential partitioning of the sample into progressively more homogeneous subsets with distinct probabilities of developing the outcome of interest. 10 First we assessed the statistical significance of all explanatory variables of interest (two-sided Yate's-corrected w 2 or Fisher's exact tests). Continuous variables were dichotomized according to the best apparent threshold by visual inspection of plots.…”

Section: Discussionmentioning

confidence: 99%

Long-term pulmonary function abnormalities and survival after allogeneic marrow transplantation

Marras

Chan

Lipton

et al. 2004

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:We studied long-term pulmonary function testing (PFT) in a retrospective cohort of 6-month survivors of allogeneic marrow transplant (BMT) between 1980 and 1997. Of 593 patients, 73, 71 and 65% had adequate data to assess for obstruction, restriction and diffusion impairments respectively. Over 5 years, mean declines in 1-s forced expiratory volume/forced vital capacity (FEV1/FVC), total lung capacity (TLC) and diffusion were 4, 7 and 17%, respectively. TLC and diffusion tended to subsequently increase. In all, 6, 12 and 35% of patients met criteria for obstruction, restriction and impaired diffusion, respectively. Obstruction was less common in recent transplants (5 vs 15%, P ¼ 0.004), while restriction and diffusion impairment rates remained stable. There was significantly greater mortality with obstruction (HR 2.0 (1.04-3.95)), and a nonstatistically significant higher mortality rate with restriction (HR 1.6 (0.95-2.75)), but not with impaired diffusion (HR ¼ 0.99 (0.65-1.50)). cGVHD ) and busulfan (OR 2.9 (1.01-8.24)) were associated with obstruction. Marrow from nonsibling or mismatched donors (OR 4.9 (2.2-10.7)) was associated with restriction. In summary, after BMT, decreased diffusion capacity is common and benign; obstruction has decreased in frequency, is rare without cGVHD, and is associated with mortality; nonsibling and mismatched donor are risk factors for restriction. The lung is often a target organ for complications after allogeneic marrow transplantation (BMT), 1,2 with pulmonary complications including infection, neoplasia, and idiopathic and iatrogenic disorders. The latter group includes pulmonary edema, peri-engraftment respiratory distress syndrome, diffuse alveolar hemorrhage, idiopathic pneumonia syndrome and obliterative bronchiolitis (OB). 3 Pulmonary function testing (PFT) after BMT is useful for predicting survival, given that PFT abnormalities correlate with nonrelapse mortality, 4 and the diagnosis of BMT complications, where PFT abnormalities make up some of the diagnostic criteria. 3,5 There are three main categories of PFT abnormalities. Obstructive defects occur when there is small airway closure or obstruction on expiration, leading to diminished forced expiratory volumes (1-s forced expiratory volume -FEV1), classically with a preserved forced vital capacity (FVC), resulting in a decrease in FEV1/FVC ratio. In the BMT population, the prototypical cause of obstruction is OB. Its occurrence has been linked to cGVHD. 6 Restriction is a pattern of decreased lung volumes (including the total lung capacity -TLC) with a preserved FEV1/FVC ratio. Idiopathic pneumonia syndrome, a diffuse noninfectious pneumonitis is a prototypical cause of restriction and may be due to thoracic irradiation, chemotherapy or other causes. Pulmonary edema, infectious pneumonitis and bronchiolitis obliterans organizing pneumonia (BOOP) may also cause restriction post-BMT. The final PFT derangement is one of diminished diffusion capacity for carbon monoxide (DCO). A low DCO often reflects thickenin...

show abstract

A study to develop clinical decision rules for the use of radiography in acute ankle injuries

Cited by 559 publications

References 28 publications

Predicting intervention in renal colic patients after emergency department evaluation

Predicting intervention in renal colic patients after emergency department evaluation

N‑methyl pyrrolidone promotes ankle fracture healing by inhibiting inflammation via suppression of the mitogen‑activated protein kinase signaling pathway

Long-term pulmonary function abnormalities and survival after allogeneic marrow transplantation

Contact Info

Product

Resources

About