Utilization of Diagnostic Radiologic Examinations in the Emergency Department of a Teaching Hospital

Validation of the Ottawa knee rules in an emergency teaching centre

“…In our study all fracture predictors of the Ottawa knee rules were negative in 54 of the 219 patients for whom knee radiography was requested (25%). None of them had a fracture, indicating a potential to reduce knee radiography requests close to that found by the original developers of the rules [4]; however, the reduction in radiography referral could be less in common practice because physicians might be uncomfortable in patients with clinical suspicion of fracture, even if patients do not fulfil the Ottawa knee rules criteria for radiographic examination [9,14]. Implementation trial to demonstrate the applicability of the Ottawa knee rules and the true reduction in the use of radiography at our institution is therefore needed.…”

“…Clinical prediction rules rationalizing radiography referral are attractive for teaching settings because the level of examiners' experience has been suggested as a possible cause of excessive radiological examination utilization in the emergency department [9]; however, although prediction rules developed by emergency experts might seem optimal, whether they would perform well when applied by users with limited level of clinical training is conjectural. The current study confirmed that the Ottawa knee rules have a 100% sensitivity and negative predictive value for knee fracture.…”

Clearing the cervical spine of adult victims of trauma.

“…Apprehension about cervical spine injuries has led to the application of these policies intended for those who are injured or at high risk to those who have minor trauma or who are at low risk of injury. Thus Eliastam et al in 1980 found that 40% of cervical spinal films were taken for medicolegal reasons. '2 Immobilisation of the cervical spine is now widespread and liberally applied and has been associated with protocol driven ordering of cervical spine radiographs."…”