Ottawa Knee Rules: Difference between revisions
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== | == Objective<br> == | ||
A decision rule used to determine the need for radiographs in acute knee injuries. | A decision rule used to determine the need for radiographs in acute knee injuries. | ||
== | == Intended Population<br> == | ||
== Method of Use<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. | 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. | ||
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#''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)'' | #''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> == | == 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" /> | Sensitivity= 1.0 -LR= 0<ref name="Flynn" /> | ||
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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%. | 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%. | ||
=== Reliability === | |||
=== Validity === | |||
=== Responsiveness === | |||
=== Miscellaneous<span class="Apple-style-span" style="font-size: 20px; font-weight: normal;"></span><br> === | |||
== 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 | *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 11:46, 9 November 2010
Original Editor - Heather Paulis , Michael Conaway, Erika Van Horebeek
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Search Strategy[edit | edit source]
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Definition/Description[edit | edit source]
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Objective
[edit | edit source]
A decision rule used to determine the need for radiographs in acute knee injuries.
Intended Population
[edit | edit source]
Method of Use[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%.
Reliability[edit | edit source]
Validity[edit | edit source]
Responsiveness[edit | edit source]
Miscellaneous
[edit | edit source]
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]
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References[edit | edit source]
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- ↑ 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.