Ottawa Knee Rules: Difference between revisions
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*'''Keywords: '''Ottawa knee rule<br> Ottawa knee rule in children<br> | *'''Keywords: '''Ottawa knee rule<br> Ottawa knee rule in children<br> | ||
== Definition/Description | == Definition/Description == | ||
The Ottawa knee rule is a previously validated clinical decision rule that was developed to allow physicians to be more selective and efficient in their use of plain radiography for patients with acute knee injuries. <ref name="1"> | The Ottawa knee rule is a previously validated clinical decision rule that was developed to allow physicians to be more selective and efficient in their use of plain radiography for patients with acute knee injuries. <ref name="1">Stiel I, Wells G, Hoag R, Sivilotti M, Cacciotti T, Verbeek R, Greenway K, McDowell I, Cwinn A, Greenberg G, Nichol G, Michael J. Implementation of the Ottawa knee rule for the use of radiography in acute knee injuries. JAMA; 1997; 278: 2075 - 2079</ref> | ||
== Objective<br> == | == Objective<br> == | ||
Revision as of 13:00, 25 December 2010
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Search Strategy[edit | edit source]
Following databases have been consulted to find information about the Ottawa knee rule:
- Database: Web of knowledge
- Keywords: Ottawa knee rule
Ottawa knee rule AND children
- Database: Pubmed
- Keywords: Ottawa knee rule
Ottawa knee rule in children
Definition/Description[edit | edit source]
The Ottawa knee rule is a previously validated clinical decision rule that was developed to allow physicians to be more selective and efficient in their use of plain radiography for patients with acute knee injuries. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Objective
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A decision rule used to determine the need for radiographs in acute knee injuries.
Intended Population
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Method of Use[1]
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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
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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]
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.
