Ottawa Knee Rules: Difference between revisions

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= Purpose  =
{{Special Tests}}
 
A clinic decision rule to help determine need for x-rays or rule out fractures of the knee after acute injury.&nbsp;&nbsp;"Plain radiographs of the knee are among the most commonly ordered radiographs in U.S. emergency departments; 60% to 80% of patients with knee pain have a knee film at an estimated annual cost of $1 billion."<sup>1</sup>92% will not have a fracture.<sup>2</sup>
 
= Criteria  =
 
If one of the following&nbsp;is present, radiographs are indicated<sup>2</sup>:&nbsp;
 
1.&nbsp; Age&gt;55 years
 
2.&nbsp; Islolated patellar tenderness without other bone tenderness
 
3.&nbsp; Tenderness of the fibular head
 
4.&nbsp; Inability to flex to 90°
 
5.&nbsp; Inability to bear weight immediately after injury and in the emergency department (4 steps) regardless of limping.
 
== Research  ==
 
26.4% reduction in adult&nbsp;patients referred for radiographs and lower medical charges when Ottawa Rules applied. <sup>2</sup>
 
46% of patients aged 3 to 18 years would not require radiograph with 92% of fracutures being identified.<sup>3</sup>
 
=== Diagnostic Accuracy<sup>4</sup>  ===
 
Adult Population:&nbsp; Sensitivity: 1.0 Specificity: .49-.56&nbsp;
 
+LR:&nbsp; 1.9-2.3 -LR: 0
 
A systematic review by Buchmann et al found a negative result on the Ottawa knee rule test is associated with a fracture probability of less than 1.5% in an adult population.<sup>5</sup>
 
Pediatric Population:&nbsp; Sensitivity:&nbsp; 1.0&nbsp; Specificity:&nbsp; .43
 
+LR:&nbsp; 1.8&nbsp; -LR:&nbsp; 0
 
== References  ==
 
(1) Jackson JL, O'Malley PG, Kroenke, K.&nbsp;&nbsp;Evaluation of acute knee pain in primary care.&nbsp;&nbsp;Ann Intern Med. 2003 Oct 7;139(7):575-88. Review.<br>
 
(2) Stiell IG, Wells GA, Hoag RH, Sivilotti ML, Cacciotti TF, Verbeek PR, Greenway KT, McDowell I, Cwinn AA, Greenberg GH, Nichol G, Michael JA.&nbsp; Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries.&nbsp; JAMA. 1997 Dec 17;278(23):2075-9.
 
(3)Khine H, Dorfman DH, Avner JR.Applicability of Ottawa knee rule for knee injury in children.&nbsp;PEDIATRIC EMERGENCY CARE.Vol. 17, No. 6
 
(4) Flynn T, Cleland J, Whitman J.&nbsp; User's guide to the musculoskeletal examination: fundamentals for the evidence-based clinician
 
(5) Bachmann LM, Haberzeth S, Steurer J, ter Riet, G.&nbsp;&nbsp;The accuracy of the Ottawa knee rule to rule out knee fractures:<br>a systematic review.&nbsp; Ann Intern Med. 2004 Jan 20;140(2):121-4. Review.<br>.&nbsp;

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