Ottawa Knee Rules: Difference between revisions
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= Purpose = | = Purpose = | ||
A clinic decision rule to help determine need for x-rays or rule out fractures of the knee after acute injury. "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."< | A clinic decision rule to help determine need for x-rays or rule out fractures of the knee after acute injury. "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 = | = Criteria = | ||
If one of the following is present, radiographs are indicated< | If one of the following is present, radiographs are indicated<sup>2</sup>: | ||
1. Age>55 years | 1. Age>55 years | ||
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== Research == | == Research == | ||
26.4% reduction in adult patients referred for radiographs and lower medical charges when Ottawa Rules applied. < | 26.4% reduction in adult 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.< | 46% of patients aged 3 to 18 years would not require radiograph with 92% of fracutures being identified.<sup>3</sup> | ||
=== Diagnostic Accuracy< | === Diagnostic Accuracy<sup>4</sup> === | ||
Adult Population: Sensitivity: 1.0 Specificity: .49-.56 | Adult Population: Sensitivity: 1.0 Specificity: .49-.56 | ||
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+LR: 1.9-2.3 -LR: 0 | +LR: 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 | 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: Sensitivity: 1.0 Specificity: .43 | Pediatric Population: Sensitivity: 1.0 Specificity: .43 | ||
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(1) Jackson JL, O'Malley PG, Kroenke, K. Evaluation of acute knee pain in primary care. Ann Intern Med. 2003 Oct 7;139(7):575-88. Review.<br> | (1) Jackson JL, O'Malley PG, Kroenke, K. Evaluation of acute knee pain in primary care. 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. Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries. JAMA. 1997 Dec 17;278(23):2075-9. | (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. Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries. 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. PEDIATRIC EMERGENCY CARE.Vol. 17, No. 6 | (3)Khine H, Dorfman DH, Avner JR.Applicability of Ottawa knee rule for knee injury in children. PEDIATRIC EMERGENCY CARE.Vol. 17, No. 6 | ||
(4) Flynn T, Cleland J, Whitman J. User's guide to the musculoskeletal examination: fundamentals for the evidence-based clinician | (4) Flynn T, Cleland J, Whitman J. User's guide to the musculoskeletal examination: fundamentals for the evidence-based clinician | ||
(5) Bachmann LM, Haberzeth S, Steurer J, ter Riet, G. The accuracy of the Ottawa knee rule to rule out knee fractures:<br>a systematic review. Ann Intern Med. 2004 Jan 20;140(2):121-4. Review.<br>. | (5) Bachmann LM, Haberzeth S, Steurer J, ter Riet, G. The accuracy of the Ottawa knee rule to rule out knee fractures:<br>a systematic review. Ann Intern Med. 2004 Jan 20;140(2):121-4. Review.<br>. | ||
Revision as of 04:54, 9 December 2009
Purpose[edit | edit source]
A clinic decision rule to help determine need for x-rays or rule out fractures of the knee after acute injury. "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."192% will not have a fracture.2
Criteria[edit | edit source]
If one of the following is present, radiographs are indicated2:
1. Age>55 years
2. Islolated patellar tenderness without other bone tenderness
3. Tenderness of the fibular head
4. Inability to flex to 90°
5. Inability to bear weight immediately after injury and in the emergency department (4 steps) regardless of limping.
Research[edit | edit source]
26.4% reduction in adult patients referred for radiographs and lower medical charges when Ottawa Rules applied. 2
46% of patients aged 3 to 18 years would not require radiograph with 92% of fracutures being identified.3
Diagnostic Accuracy4[edit | edit source]
Adult Population: Sensitivity: 1.0 Specificity: .49-.56
+LR: 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.5
Pediatric Population: Sensitivity: 1.0 Specificity: .43
+LR: 1.8 -LR: 0
References[edit | edit source]
(1) Jackson JL, O'Malley PG, Kroenke, K. Evaluation of acute knee pain in primary care. Ann Intern Med. 2003 Oct 7;139(7):575-88. Review.
(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. Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries. 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. PEDIATRIC EMERGENCY CARE.Vol. 17, No. 6
(4) Flynn T, Cleland J, Whitman J. User's guide to the musculoskeletal examination: fundamentals for the evidence-based clinician
(5) Bachmann LM, Haberzeth S, Steurer J, ter Riet, G. The accuracy of the Ottawa knee rule to rule out knee fractures:
a systematic review. Ann Intern Med. 2004 Jan 20;140(2):121-4. Review.
.
