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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Recognition and management of pediatric fractures by pediatric residents.
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Recognition and management of pediatric fractures by pediatric residents.

机译：小儿居民对小儿骨折的认识和管理。

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BACKGROUND: Competence in basic orthopedic assessment and interpretation of radiographs is important for pediatricians because appropriate initial management of fractures can expedite therapy and minimize morbidity. However, requirements for training in orthopedics and radiology are poorly defined in pediatric residency programs. OBJECTIVE: To assess the ability of pediatric residents to recognize and to manage appropriately pediatric fractures. METHODS: This study involved administration of a case-based questionnaire with radiographs to volunteer categorical pediatric residents in 3 geographically diverse training programs. The diagnosis and management of 8 orthopedic complaints were evaluated. Responses were scored according to the number of features identified accurately, including the presence or absence of a fracture. Residents who were able to identify a fracture were assessed with respect to their ability to classify the fracture and to provide initial management. The study was pretested with a group of pediatric emergency medicine attending physicians, to establish the suitability of the cases. RESULTS: Among the 3 residency sites, 102 of 190 eligible pediatric residents (53.7%) participated, yielding 95 completed questionnaires. The mean number of cases in which a resident correctly answered the question, "Is a fracture present?" and correctly identified the fractured bone (if a fracture was present) was 6.5 +/- 1.2 of 8 cases (81.6%; 95% confidence interval: 78.5-84.7%). The diagnostic accuracy of Salter-Harris classification in cases in which such fractures were present was 40.9%. The mean score of correctly identified features for the resident group was 38.5 +/- 9.4, of a possible 64 points (proportion correct: 60.1%; 95% confidence interval: 57.2-63%). There was a small but significant difference in mean correct responses between first-year residents (proportion correct: 55.4%; 95% confidence interval: 50.8- 60.3%) and third-year residents (proportion correct: 65.1%; 95% confidence interval: 60.7-69.5%). There was no association between the proportion of correct responses and whether or not residents had taken radiology or orthopedics elective courses in medical school. Overall, 43% of cases were both identified and managed correctly by the pediatric residents. CONCLUSIONS: For residents from the participating training programs, skills in recognizing and managing pediatric fractures were suboptimal. Additional review of training requirements is necessary to identify more clearly areas of improvement for current curricula.
机译：背景：对儿科医生来说，基本的骨科评估和X线片解释能力很重要，因为适当的骨折初始治疗可以加快治疗速度，并降低发病率。但是，在儿科住院医师项目中，对骨科和放射科培训的要求很少。目的：评估小儿科居民识别和适当处理小儿骨折的能力。方法：本研究涉及一项基于病例的问卷调查表，该表带有X光片，以自愿的方式在3个不同的培训项目中为儿科分类居民提供服务。评估了8例骨科疾病的诊断和处理。根据准确识别的特征数量（包括是否存在骨折）对反应进行评分。对能够识别骨折的居民进行分类和提供初步治疗的能力方面的评估。该研究在一组儿科急诊医师的陪同下进行了预测试，以确定病例的适用性。结果：在3个居民点中，有190名合格的儿科居民中有102名（53.7％）参加了调查，共完成了95份问卷。居民正确回答“是否存在骨折？”的平均病例数并正确鉴定出骨折的骨头（如果存在骨折）为8例患者的6.5 +/- 1.2（81.6％; 95％置信区间：78.5-84.7％）。在存在此类骨折的情况下，Salter-Harris分类的诊断准确性为40.9％。居民组正确识别的特征的平均评分为38.5 +/- 9.4，满分为64（正确比例：60.1％; 95％置信区间：57.2-63％）。第一年居民（正确比例：55.4％; 95％置信区间：50.8-60.3％）与第三年居民（正确比例：65.1％; 95％置信区间： 60.7-69.5％）。正确回答的比例与居民是否在医学院接受过放射学或骨科选修课之间没有关联。总体而言，有43％的病例是由儿科居民正确识别和处理的。结论：对于参加培训课程的居民来说，识别和处理小儿骨折的技能欠佳。有必要对培训要求进行额外的审查，以更清楚地确定当前课程的改进领域。

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