The Accuracy of the Ottawa Knee Rule To Rule Out Knee Fractures

Bachmann, Lucas M.; Haberzeth, S; Steurer, Johann; Riet, Gerben ter

doi:10.7326/0003-4819-140-5-200403020-00013

Cited by 93 publications

(50 citation statements)

References 14 publications

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“…46 Dowling concluded that the Ottawa ankle rule can be used in the pediatric population (>5 years) to rule out fractures. 47 Bachmann et al 48 also validated the Ottawa knee rule in 2004. The Ottawa knee rule consists of answering five questions asking whether the patient is above 55 years of age, has isolated tenderness of the patella, has tenderness over the head of the fibula, is unable to flex the knee to 90°, and is unable to bear weight for four steps.…”

Section: History and Physical Examinationmentioning

confidence: 99%

“…Bachmann concluded that the Ottawa knee rule is useful for excluding fracture; however, they did recommend further large-scale testing for validation because they prefer sensitivities above 98.5%. 48 The studies of upper extremity fractures that were identified based on the inclusion criteria focused on elbow or wrist injuries. Figures 2-6 depict forest plots of the sensitivities, specificities, positive LR, and negative LR of history and physical examination in all of the included trials.…”

Section: History and Physical Examinationmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic Accuracy of History, Physical Examination, and Bedside Ultrasound for Diagnosis of Extremity Fractures in the Emergency Department: A Systematic Review

Joshi

Lira

Mehta

et al. 2013

Academic Emergency Medicine

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Objectives: Understanding history, physical examination, and ultrasonography (US) to diagnose extremity fractures compared with radiography has potential benefits of decreasing radiation exposure, costs, and pain and improving emergency department (ED) resource management and triage time. Methods:The authors performed two electronic searches using PubMed and EMBASE databases for studies published between 1965 to 2012 using a strategy based on the inclusion of any patient presenting with extremity injuries suspicious for fracture who had history and physical examination and a separate search for US performed by an emergency physician (EP) with subsequent radiography. The primary outcome was operating characteristics of ED history, physical examination, and US in diagnosing radiologically proven extremity fractures. The methodologic quality of the studies was assessed using the quality assessment of studies of diagnostic accuracy tool (QUADAS-2).Results: Nine studies met the inclusion criteria for history and physical examination, while eight studies met the inclusion criteria for US. There was significant heterogeneity in the studies that prevented data pooling. Data were organized into subgroups based on anatomic fracture locations, but heterogeneity within the subgroups also prevented data pooling. The prevalence of fracture varied among the studies from 22% to 70%. Upper extremity physical examination tests have positive likelihood ratios (LRs) ranging from 1.2 to infinity and negative LRs ranging from 0 to 0.8. US sensitivities varied between 85% and 100%, specificities varied between 73% and 100%, positive LRs varied between 3.2 and 56.1, and negative LRs varied between 0 and 0.2. Conclusions:Compared with radiography, EP US is an accurate diagnostic test to rule in or rule out extremity fractures. The diagnostic accuracy for history and physical examination are inconclusive. Future research is needed to understand the accuracy of ED US when combined with history and physical examination for upper and lower extremity fractures.ACADEMIC EMERGENCY MEDICINE 2013; 20:1-15 © 2013 by the Society for Academic Emergency Medicine E xtremity injuries are among the most frequent reasons for visiting the emergency department (ED). These injuries are significant, comprising over 42.4 million injury-related visits to the ED in 2006. 1The typical work-up of the injured patient generally involves a medical provider obtaining a history and physical examination, often followed by radiologic imaging. However, many times the radiologic imaging may be negative or inconclusive, which calls to question whether the imaging contributed to the management or outcome of the patient. Studies have shown that often the imaging obtained is unnecessary and results in radiation exposure to patients and increased ED wait times. 2There is a low rate of positive radiography when assessing for fractures as evidenced by a retrospective review by Bentohami et al.,3 in which only 50% of upper extremity x-rays showed fractures, and another ...

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Section: History and Physical Examinationmentioning

confidence: 99%

Section: History and Physical Examinationmentioning

confidence: 99%

Diagnostic Accuracy of History, Physical Examination, and Bedside Ultrasound for Diagnosis of Extremity Fractures in the Emergency Department: A Systematic Review

Joshi

Lira

Mehta

et al. 2013

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…9,22,30,32,45,59,65,68 The intent of this education is to reduce the uncertainty inherent in clinical practice by defining how to use examination findings to make decisions about which course of action to take with specific patients. 71 For instance, during the typical patient examination performed by physical therapists, historical information, and baseline physical examination findings are obtained, which include ambulatory ability, motion and functional limitations, palpation and clinical diagnostic tests (orthopaedic special tests).…”

Section: Evidence Of Competency Within Musculoskeletal Medicine and Ementioning

confidence: 99%

Physical Therapist Practice and the Role of Diagnostic Imaging

Boyles¹,

Gorman²,

Pinto³

et al. 2011

J Orthop Sports Phys Ther

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“…For this purpose, it is important that such CPRs have high sensitivity. Metaanalysis of validation studies show these rules achieve high sensitivity that is comparable to the Alvarado score at a cut-off of five points (ankle rule -97.6% [48], knee rule -98.5% [49] and Alvarado score at cut-off of five points -99%).…”

Section: Discussionmentioning

confidence: 99%