Validation of the Ottawa Knee Rule in Iran: a prospective study

Jalili, Mohammad; Gharebaghi, H.

doi:10.1136/emj.2009.080267

Cited by 13 publications

(8 citation statements)

References 19 publications

(38 reference statements)

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“…In Similarly, the specificity matching in accordance (42.02%) to our study has been 2,5,12,19 reported by few other studies as well. According to our study, implemen ng the OKR would have resulted in an overall reduc on in the use of radiographs by 37.61%.…”

Section: Discussionsupporting

confidence: 93%

Validity of Ottawa Knee Rules at a Teaching Hospital of Eastern Nepal

Mishra

Nepal²,

Parajuli³

2021

Birat J. Health Sci.

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Introduction: Knee injuries are encountered frequently in Orthopedic emergency and Outpatient departments. Radiographs are routinely ordered in them, but not all of them demonstrate clear fractures. The decision for radiography based on subjective evaluation can help to reduce cost, decrease waiting time, and unnecessary radiation exposure. We lack this information in our context. Objective: The objective of this study was to find the validity of the Ottawa knee rule (OKR) in patients presenting with acute knee injuries at a teaching hospital in eastern Nepal. Methodology: A cross-sectional study was conducted from March 2018 to February 2019 including 210 cases of acute knee injuries. The patients were evaluated as per OKR and their X-rays were evaluated too. Collected data were entered in MS Excel and analyzed by SPSS for validity. Results: Out of the total of 210 eligible patients (122 males and 88 females) with a mean age of 43.97 years, the radiography rate was 100% but the yield rate was only 10.5%. Overall 69% of patients presented to the hospital within 24 hours of the injury and direct hit/trauma was the commonest mode of injury. Patella fractures were commonest followed by proximal tibia fractures. There was a high sensitivity of 100% and a specificity of 42.02%. The rule yielded a Positive and Negative Predictive value of 16.79% and 100%, respectively. The OKR, if applied correctly, could result in radiography rate reduction by 37.61%. The Fisher exact test result was significant at p<0.05. Conclusion: OKRs is a valid tool to predict fractures in patients who has a history of acute knee injuries without chances of missing fractures. This rule can reduce unnecessary radiography in our setup as well.

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Section: Discussionsupporting

confidence: 93%

Validity of Ottawa Knee Rules at a Teaching Hospital of Eastern Nepal

Mishra

Nepal²,

Parajuli³

2021

Birat J. Health Sci.

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“…In our study, the 43% potential reduction in radiography if the OKR was correctly applied is consistent with studies performed in Canada, Iran and Spain, which calculated reductions of 31.2%, 41% and 49%, respectively. 6,17,19 Our value is, however, higher than the rate in the original report by Stiell and colleagues (26.4%). 1 Finally, although the patient's time spent in ED was not specifically examined in our study, using the OKR could shorten the waiting time for our patients in ED.…”

Section: Discussioncontrasting

confidence: 78%

“…Since the development of the OKR in 1995, 2 its excellent sensitivity (near 100%) has been argued and found indisputable across many countries. 1,[4][5][6][7][8]17 However, few published studies have investigated the local generalisability of the rule, particularly in Australia. Our retrospective clinical audit evaluated OKR performance and referrer compliance in a tertiary hospital in South Australia.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Ottawa knee rule in adults: A single centre study

Sims

Chau

Davies

2020

J of Medical Radiation Sci

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Introduction This clinical audit aimed to evaluate performance of the Ottawa Knee Rule (OKR) and degree of compliance by emergency referrers for acute knee injuries in adults. Methods Knee radiography requests were analysed retrospectively for eligibility. Data were extracted from eligible requests under headings describing the OKR criteria, patient history, diagnosis and referrer profession. Sensitivity, specificity, negative likelihood ratio and positive likelihood ratio were calculated with 95% CI for the entire sample and each profession (consultant doctors, resident medical officers [RMO], physiotherapists and triage nurses) individually. The frequency of each OKR criterion and correlation with fracture, referrer compliance to the rule and the relative reduction in radiography were also calculated. Results Of 713 patients identified, 149 were enrolled by the eligibility criteria. The overall sensitivity, specificity, negative likelihood ratio and positive likelihood ratio of the OKR for knee fracture were 71% (95%CI, 49‐87%), 46% (95%CI, 37‐55%), 0.64 (95%CI, 0.33‐1.22) and 1.3 (95%CI, 0.96‐1.76), respectively. Physiotherapists and triage nurses demonstrated better rule performance than consultant doctors and RMOs, with a sensitivity of 100% and negative likelihood ratio of 0.0. Physiotherapists were most compliant at 73% (19/26). Only 85 requests were OKR positive and, when abiding by the rule, this would have reduced radiography by 43% (64/149). Conclusions In this first Australian study, moderate OKR performance and variable compliance by emergency referrers were observed. This led to unnecessary irradiation of patients without a fracture. The findings suggest emergency referrers could benefit from education on applying and documenting the OKR on radiography requests.

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“…• Not reported • 100%, 42.8%, 50% [190] • 95%, 44%, 50% [191] • Not reported * A systematic review study. The mixed evidence protocol is based on four steps.…”

Section: Predictive Performance Usability and Post-implementation Imp...mentioning

confidence: 99%

Developing a framework for evidence-based grading and assessment of predictive tools for clinical decision support

Khalifa

Magrabi

Gallego

2019

BMC Med Inform Decis Mak

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BackgroundClinical predictive tools quantify contributions of relevant patient characteristics to derive likelihood of diseases or predict clinical outcomes. When selecting predictive tools for implementation at clinical practice or for recommendation in clinical guidelines, clinicians are challenged with an overwhelming and ever-growing number of tools, most of which have never been implemented or assessed for comparative effectiveness. To overcome this challenge, we have developed a conceptual framework to Grade and Assess Predictive tools (GRASP) that can provide clinicians with a standardised, evidence-based system to support their search for and selection of efficient tools.MethodsA focused review of the literature was conducted to extract criteria along which tools should be evaluated. An initial framework was designed and applied to assess and grade five tools: LACE Index, Centor Score, Well’s Criteria, Modified Early Warning Score, and Ottawa knee rule. After peer review, by six expert clinicians and healthcare researchers, the framework and the grading of the tools were updated.ResultsGRASP framework grades predictive tools based on published evidence across three dimensions: 1) Phase of evaluation; 2) Level of evidence; and 3) Direction of evidence. The final grade of a tool is based on the highest phase of evaluation, supported by the highest level of positive evidence, or mixed evidence that supports a positive conclusion. Ottawa knee rule had the highest grade since it has demonstrated positive post-implementation impact on healthcare. LACE Index had the lowest grade, having demonstrated only pre-implementation positive predictive performance.ConclusionGRASP framework builds on widely accepted concepts to provide standardised assessment and evidence-based grading of predictive tools. Unlike other methods, GRASP is based on the critical appraisal of published evidence reporting the tools’ predictive performance before implementation, potential effect and usability during implementation, and their post-implementation impact. Implementing the GRASP framework as an online platform can enable clinicians and guideline developers to access standardised and structured reported evidence of existing predictive tools. However, keeping GRASP reports up-to-date would require updating tools’ assessments and grades when new evidence becomes available, which can only be done efficiently by employing semi-automated methods for searching and processing the incoming information.

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Validation of the Ottawa Knee Rule in Iran: a prospective study

Abstract: Prospective validation has shown that the OKR is a highly sensitive tool for detecting knee fractures and has the potential to reduce the number of radiographs in patients with acute knee injuries.

Cited by 13 publications

References 19 publications

Validity of Ottawa Knee Rules at a Teaching Hospital of Eastern Nepal

Validity of Ottawa Knee Rules at a Teaching Hospital of Eastern Nepal

Validation of the Ottawa knee rule in adults: A single centre study

Developing a framework for evidence-based grading and assessment of predictive tools for clinical decision support

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