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| '''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.]] |
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| == Purpose<br> == | | == Purpose<br> == |
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| A decision rule used to determine the need for radiographs in acute knee injuries.
| | == Technique<br> == |
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| == Technique<br> ==
| | == Evidence<br> == |
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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.
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| '''1.''' ''Age 55 or older''
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| '''2.''' ''Isolated tenderness of the patella (no bone tenderness of knee other than patella)''
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| '''3.''' ''Tenderness of the head of the fibula''
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| '''4.''' ''Inability to flex to 90 degrees''
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| '''5.''' ''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)''
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| == 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><br> == | |
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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%.
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| == Resources == | | == Resources == |
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| Ottawa Hospital Research Institute
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| <div class="researchbox"></div> | | <div class="researchbox"> |
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| == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == |
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