Multicenter Comparison of Two Clinical Decision Rules for the Use of Radiography in Acute, High-Risk Knee Injuries

Seaberg, David C.; Yealy, Donald M.; Lukens, Thomas W.; Auble, Thomas E.; Mathias, Susan D.

doi:10.1016/s0196-0644(98)70092-7

Cited by 67 publications

(38 citation statements)

References 13 publications

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“…59 There are a number of other available CDRs to aid the clinician in decision making. 22,52,53,58,[60][61][62]64,66 CDRs not only help in decision making but prevent needless imaging, reduce or eliminate radiation exposure, and keep healthcare costs down. One of the original protocols was the Brand protocol, which was developed in 1982 and specifically designed to curb excessive utilization of radiography, without compromising quality of care or increasing risk for poor outcomes.…”

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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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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“…The rules were introduced and previously validated in north America, where other studies have shown the sensitivity to be between 84. 6% [7], 97% [8], 98% [9], and 100% [3]. This study shows the rules to be an effective tool in deciding which patients with isolated acute knee injury do not require knee radiography when used by doctors in ED.…”

Section: Discussionmentioning

confidence: 82%

Are Ottawa knee rules useful in actual trauma care?

Nagpal

Marathe

2007

Open Medicine

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AbstractAcute knee injuries are a common presentation to the emergency department(ED). Ottawa knee rules (OKR) have shown to reduce the number of radiographs in these patients in North American studies and a fracture rate of 5% has been reported. Based on this, we tested the hypothesis that it was possible to decrease the number of x-ray films obtained after a knee trauma without delayed fracture diagnosis by means of the Ottawa knee rules in British set up. A total of 118 adult patients with acute Knee injuries were studied. A checklist in an easy-to-use format was produced to act as an aide-memoir and to encourage clinicians to apply the OKR in their decision making. Sixty patients were studied before introducing the check list stickers of OKR and fifty eight were studied after introducing the stickers. The OKR were found to have been obeyed in 24 (40%) of patients in the group which did not have stickers. In the group assessed without an OKR sticker, 28 (46.7%) of patients had knee radiography, compared with 29 (50%) of patients in the group who were assessed with an OKR sticker. There was no decrease in the number of x-rays after following the Ottawa Knee Rules (OKR).

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“…The PDR was developed in 1994 from a twophase study [1,7,10]. Logistic regression to review the clinical indicators of 201 patients retrospectively was phase one, while phase 2 was a prospective study of 133 patients presenting with a knee injury.…”

Section: Discussionmentioning

confidence: 99%

“…Reliable indicators of a fracture were identified as patient age, mechanism of injury, and inability to ambulate. When combined to make the Pittsburgh rules, the specificity was found to be 80% with a sensitivity of 100% [10].…”

Section: Discussionmentioning

confidence: 99%

“…The Ottawa criteria, however, state that any weight transfer is considered bearing weight [12][13][14]. In the prospective multicenter study by Seaberg et al, PDR had a higher sensitivity than OKR 99% compared to 97% respectively, as well as significantly higher specificity of 60% for PDR and 27% for OKR [10,13]. In a recently published study by Tung C, et al, PDR was found to have significantly higher specificity 51%, compared to OKR rules 27%, with equal pooled sensitivity 0.86 [14].…”

Section: Discussionmentioning

confidence: 99%

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X-rays for Acute Knee injuries: pre- and post- Pittsburgh Decision Rules implementation. A district general hospital experience

Ashry

Gamal

Challagundla

et al. 2016

Ortop Traumatol Rehabil

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SUMMARYBackground. We wanted to assess the number of unnecessary radiographs done for acute knee injury patients and the accuracy of the Pittsburgh decision rules.Material and methods. A retrospective observational study was done to look at the acute knee injury patients presented to a district general hospital Accident and Emergency Department from August 2011 till August 2013. We assessed the following parameters: sex, age, mechanism of injury, weight-bearing status and incidence of fractures in patients subjected to plain radiograph. A prospective study was then done from April 2014-August 2014 following implementation of the Pittsburgh decision rules.Results. 24% of the patients had knee X-ray, compared to 72.12% in the first cycle. 36.8% had fracture, compared to 6.1% first cycle, with 66.7 % reduction in x-rays. Pittsburgh decision rules sensitivity was 100% and specificity 85.3%, positive predictive value 45.8% and accuracy 87%.Conclusions. 1. The Pittsburgh decision rules is highly sensitive, specific and accurate in determining the need of X-ray in acute knee Injuries. 2. We found that the Pittsburgh decision rules performs well in our hospital, which coincides with previously published literature.

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Multicenter Comparison of Two Clinical Decision Rules for the Use of Radiography in Acute, High-Risk Knee Injuries

Cited by 67 publications

References 13 publications

Physical Therapist Practice and the Role of Diagnostic Imaging

Physical Therapist Practice and the Role of Diagnostic Imaging

Are Ottawa knee rules useful in actual trauma care?

X-rays for Acute Knee injuries: pre- and post- Pittsburgh Decision Rules implementation. A district general hospital experience

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