Ottawa Knee Rules: Difference between revisions
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
<div class="noeditbox">Welcome to [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox"> | |||
'''Original Editor '''- [[User:Heather Paulis|Heather Paulis]] , [[User:Michael Conaway|Michael Conaway]], [[User:Erika Van Horebeek|Erika Van Horebeek]] | |||
'''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | |||
</div> | |||
<div class="editorbox"> | <div class="editorbox"> | ||
'''Original Editor '''- | '''Original Editor '''- Your name will be added here if you created the original content for this page. | ||
'''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | ||
</div> | </div> | ||
== Objective<br> == | |||
== Intended Population<br> == | |||
== Method of Use == | |||
== Reference<br> == | |||
== Evidence == | |||
=== Reliability === | |||
=== Validity === | |||
=== Responsiveness === | |||
=== Miscellaneous<span style="font-size: 20px; font-weight: normal;" class="Apple-style-span"></span><br> === | |||
== Links == | |||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | |||
<div class="researchbox"> | |||
<rss>Feed goes here!!|charset=UTF-8|short|max=10</rss> | |||
</div> | |||
== References == | |||
References will automatically be added here, see [[Adding References|adding references tutorial]]. | |||
<references /> | |||
== Search Strategy == | |||
add text here related to databases searched, keywords, and search timeline <br> | |||
== Definition/Description == | |||
add text here <br> | |||
== Purpose<br> == | == Purpose<br> == | ||
A decision rule used to determine the need for radiographs in acute knee injuries. | |||
== Technique<ref name="Flynn">Flynn T, Cleland J, Whitman J. Users Guide to Musculoskeletal Examination: Fundamentals for the Evidence Based Clinician: Evidence in Motion; 2008.</ref><br> == | == Technique<ref name="Flynn">Flynn T, Cleland J, Whitman J. Users Guide to Musculoskeletal Examination: Fundamentals for the Evidence Based Clinician: Evidence in Motion; 2008.</ref><br> == | ||
The decision rule is applied to any patient presenting with an acute knee injury. If '''any '''of the 5 following findings are present, the patient should have radiographic examination. | |||
#''Age 55 or older'' | |||
#''Isolated tenderness of the patella (no bone tenderness of knee other than patella)'' | |||
#''Tenderness of the head of the fibula'' | |||
#''Inability to flex to 90 degrees'' | |||
#''Inability to bear weight both immediately and in the emergency department for 4 steps (unable to transfer weight twice on each lower limb regardless of limping)'' | |||
== Evidence <ref>Stiell IG, Greenberg GH, Wells GA, McDowell I, Cwinn A, Smith NA, Cacciotti TF, Marco LA. Prospective validation of a Decision Rule for the use of Radiography in Acute Knee Injuries. JAMA. 1996;275:611-615</ref> == | |||
== | Sensitivity= 1.0 -LR= 0<ref name="Flynn" /> | ||
Specificity= .49-.56 +LR = 1.9-2.3<ref name="Flynn" /> | |||
An estimated 1.3 million patients are seen annually in US emergency departments with acute knee trauma.<ref name="McCaig">McCaig LF. national Hospital Ambulatory Medial Care Survey: 1992 emergency department summary. Advance Data. 1994;245:1-12.</ref><ref>National Center for Health Statistics. National Hospital AmbulatoryMedical Care Survey 1992. Hyattsville, MD:National Center for Health Statistics; 1994.</ref> Although only 6% of these patients have suffered a fracture, the vast majority undergo plain radiography of the knee.<ref>Naational Center for Health Statistics. National Hospital Ambulatory Medical Care Survey 1992. Hyattsville, MD:National Center for health Statistics; 1994.</ref><ref name="Steill et al">Stiell IG, Wells GA, McDowell I, et al. Use of Radiography in acute knee injuries: need for clinical decision rules. Acad Emerg Med. 1995;2:966-973.</ref><ref name="Gleadhill et al">Gleadhill DNS, Thomson JY, Simms P. Can more efficient use be made of x-ray examinations in the accident and emergency department? BMJ. 1987;294;943-947.</ref><ref name="Gratton et al">Gratton MC, Salomone JA III, Watson WA. Clinically Significant radiograph misinterpretationsat an emergency medicine residency program. Ann Emerg Med. 1990;19:497-502.</ref><ref>McConnochie KM, Roghmann KJ, Pasternack J, Monroe DJ, Monaco LP. Prediction rules for selective radiographic assessment of extremity injuriesin children and adolescents. Pediatrics. 1990;86:45-57.</ref> More than 92% of these radiographic results are negative for fractures and exemplify the many low cost, but high volume tests that add to health care costs.<ref name="Moloney et al">Moloney TW, Rogers DE. Medical Technology: a different viewof the contentious debate over costs. N Eng J Med. 1979;301:1413-1419.</ref><ref name="Angell">Angell M. Cost containment and the physician. JAMA. 1985;254:1203-1207.</ref> The Ottawa knee decision rule was developed in an attempt to allow physicians to be more selective with radiography, without missing clinically important fractures.<ref name="Steill IG">Stiell IG, Greenberg GH, Wells GA, et al. Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med. 1995;26:405-413.</ref> A prospective study by Stiell, et al (1996), have found the rules to be 100% sensitive for identifying fractures of the knee with the potential relative reduction in the use of radiography to be estimated at 28%. | |||
== Resources == | == Resources == | ||
Eur Radiol. 2002 May;12(5): 1218-20 Epub 2001 Nov 14. | *Eur Radiol. 2002 May;12(5): 1218-20 Epub 2001 Nov 14. | ||
*Ottawa Hospital Research Institute | |||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
Revision as of 11:43, 9 November 2010
Welcome to Vrije Universiteit Brussel's Evidence-based Practice project. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!
Original Editor - Heather Paulis , Michael Conaway, Erika Van Horebeek
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Original Editor - Your name will be added here if you created the original content for this page.
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Objective
[edit | edit source]
Intended Population
[edit | edit source]
Method of Use[edit | edit source]
Reference
[edit | edit source]
Evidence[edit | edit source]
Reliability[edit | edit source]
Validity[edit | edit source]
Responsiveness[edit | edit source]
Miscellaneous
[edit | edit source]
Links[edit | edit source]
Recent Related Research (from Pubmed)[edit | edit source]
Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
Search Strategy[edit | edit source]
add text here related to databases searched, keywords, and search timeline
Definition/Description[edit | edit source]
add text here
Purpose
[edit | edit source]
A decision rule used to determine the need for radiographs in acute knee injuries.
Technique[1]
[edit | edit source]
The decision rule is applied to any patient presenting with an acute knee injury. If any of the 5 following findings are present, the patient should have radiographic examination.
- Age 55 or older
- Isolated tenderness of the patella (no bone tenderness of knee other than patella)
- Tenderness of the head of the fibula
- Inability to flex to 90 degrees
- Inability to bear weight both immediately and in the emergency department for 4 steps (unable to transfer weight twice on each lower limb regardless of limping)
Evidence [2][edit | edit source]
Sensitivity= 1.0 -LR= 0[1]
Specificity= .49-.56 +LR = 1.9-2.3[1]
An estimated 1.3 million patients are seen annually in US emergency departments with acute knee trauma.[3][4] Although only 6% of these patients have suffered a fracture, the vast majority undergo plain radiography of the knee.[5][6][7][8][9] More than 92% of these radiographic results are negative for fractures and exemplify the many low cost, but high volume tests that add to health care costs.[10][11] The Ottawa knee decision rule was developed in an attempt to allow physicians to be more selective with radiography, without missing clinically important fractures.[12] A prospective study by Stiell, et al (1996), have found the rules to be 100% sensitive for identifying fractures of the knee with the potential relative reduction in the use of radiography to be estimated at 28%.
Resources[edit | edit source]
- Eur Radiol. 2002 May;12(5): 1218-20 Epub 2001 Nov 14.
- Ottawa Hospital Research Institute
Recent Related Research (from Pubmed)[edit | edit source]
Failed to load RSS feed from http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1-GbkCVmYw_52ZU04g_4GXSFKtr5KXDF4NWQ0YRQCLO0r-zEG1|charset=UTF-8|short|max=10: Error parsing XML for RSS
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ 1.0 1.1 1.2 Flynn T, Cleland J, Whitman J. Users Guide to Musculoskeletal Examination: Fundamentals for the Evidence Based Clinician: Evidence in Motion; 2008.
- ↑ Stiell IG, Greenberg GH, Wells GA, McDowell I, Cwinn A, Smith NA, Cacciotti TF, Marco LA. Prospective validation of a Decision Rule for the use of Radiography in Acute Knee Injuries. JAMA. 1996;275:611-615
- ↑ McCaig LF. national Hospital Ambulatory Medial Care Survey: 1992 emergency department summary. Advance Data. 1994;245:1-12.
- ↑ National Center for Health Statistics. National Hospital AmbulatoryMedical Care Survey 1992. Hyattsville, MD:National Center for Health Statistics; 1994.
- ↑ Naational Center for Health Statistics. National Hospital Ambulatory Medical Care Survey 1992. Hyattsville, MD:National Center for health Statistics; 1994.
- ↑ Stiell IG, Wells GA, McDowell I, et al. Use of Radiography in acute knee injuries: need for clinical decision rules. Acad Emerg Med. 1995;2:966-973.
- ↑ Gleadhill DNS, Thomson JY, Simms P. Can more efficient use be made of x-ray examinations in the accident and emergency department? BMJ. 1987;294;943-947.
- ↑ Gratton MC, Salomone JA III, Watson WA. Clinically Significant radiograph misinterpretationsat an emergency medicine residency program. Ann Emerg Med. 1990;19:497-502.
- ↑ McConnochie KM, Roghmann KJ, Pasternack J, Monroe DJ, Monaco LP. Prediction rules for selective radiographic assessment of extremity injuriesin children and adolescents. Pediatrics. 1990;86:45-57.
- ↑ Moloney TW, Rogers DE. Medical Technology: a different viewof the contentious debate over costs. N Eng J Med. 1979;301:1413-1419.
- ↑ Angell M. Cost containment and the physician. JAMA. 1985;254:1203-1207.
- ↑ Stiell IG, Greenberg GH, Wells GA, et al. Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med. 1995;26:405-413.
