Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries

Stiell, Ian G.; Wells, George A.; Hoag, R. H.; Sivilotti, Marco L.A.; Cacciotti, T. F.; Verbeek, P. Richard; Greenway, Kathleen; McDowell, Ian; Cwinn, A. Adam; Greenberg, Gary H.; Nichol, Graham; Michael, J. A.

doi:10.1001/jama.278.23.2075

Cited by 53 publications

(48 citation statements)

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“…The reason we chose to focus on upper extremity is because the literature has derived and validated decision rules for the lower extremity ankle and knee with the Ottawa ankle 44 and knee 45 rules. These rules are combinations of history and physical examination findings for the lower extremity that help guide imaging decision-making.…”

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

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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%

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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“…Kapalı redüksiyon açısından ortopedistin değerlen-dirmesi, gerek duyulursa ameliyathane şartlarında açık redüksiyon yapılması önerilmektedir. [20] Omuz Omuz eklemi yaralanmalarında ön-arka radyografi dışında gerçek ön-arka (glenoide tanjansiyel) ve glenoide dik açıda alınan transskapular Y grafi kullanılır. Hastanın kolunu 60 derece abdüksiyo-na getirerek alınan aksiller radyografi ise travmalı hastada ağrılı olması nedeniyle çok tercih edilmez.…”

Section: Klavikulaunclassified

Radiologic examinations in orthopedic emergencies

Kılıçgün¹

2013

TOTBİD Dergisi

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“…Attempts have been made to categorize a CDR based on the criteria of the method of derivation, the validation of the CDR to ensure that its repeated use leads to the same results, and its predictive value. 39,40,56,57,75,82,84,[98][99][100][101][102][104][105][106][107][108][109][110][111][112][113][114][115] CDRs have been developed primarily for use by emergency department physicians. Most CDRs are developed for maximum sensitivity to avoid missing relevant findings that may indicate the need for further testing or to guide treatment selection.…”

Section: Appropriate Use Of Radiographsmentioning

confidence: 99%

“…106,[112][113][114] If any of the 5 criteria are present, radiographs are required. Similarly, the rules use 6 criteria to describe situations where the rules cannot be applied.…”

Section: Indications For Radiography If Any Of the Following Are Presentmentioning

confidence: 99%

“…The Ottawa knee rules are 97% sensitive and 27% specific for knee fractures. 112,114 The Ottawa ankle rules for radiography (Table 2) and the Ottawa foot rules for radiography (Table 3) each use 3 inclusion criteria. 61,98,99,103,104,110 The Ottawa ankle rules are 100% sensitive and 40% specific.…”

Section: Indications For Radiography If Any Of the Following Are Presentmentioning

confidence: 99%

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Musculoskeletal Imaging in Physical Therapist Practice

Deyle¹

2005

J Orthop Sports Phys Ther

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This article presents an overview of current concepts of evidence-based diagnosis using a variety of imaging modalities for a broad spectrum of musculoskeletal conditions and syndromes. There is limited but increasing evidence that physical therapists appropriately use diagnostic studies in clinical practice. Pathology revealed by diagnostic studies must be viewed in the context of the complete examination, as pathology is common in the asymptomatic population. Special Key Words: clinical decision rule, diagnosis, diagnostic imagingD iagnostic imaging is an important tool for the differential diagnosis of many musculoskeletal conditions. Physical therapists working in direct access roles are assuming greater diagnostic responsibility. The role of musculoskeletal imaging in physical therapist practice is therefore becoming increasingly important.127 Availability of diagnostic studies to physical therapists may vary greatly depending upon many factors within the practice setting. US Army physical therapists functioning as direct access providers have long held privileges for ordering imaging studies and laborator y tests considered essential to their diagnostic role. 7,12,43,47,48 Physical therapists who do not have the privilege to order imaging studies, especially with the greater direct access role conferred to physical therapists, should still be familiar with the indications and role of diagnostic radiology. In these situations, physical therapists should establish the proper professional interactions with individuals who can facilitate ordering necessary imaging studies. The Evidence Regarding the Use of Musculoskeletal Imaging Studies by Physical TherapistsThere is limited but increasing evidence that physical therapists appropriately use diagnostic studies in clinical practice. A study comparing the care administered by physical therapists with orthopaedic surgeons in the primary management of musculoskeletal problems determined that the physical therapists were most cost effective, with no

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Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries

Cited by 53 publications

References 0 publications

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

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

Radiologic examinations in orthopedic emergencies

Musculoskeletal Imaging in Physical Therapist Practice

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