Review: the Ottawa knee rule accurately rules out knee fractures and can substantially reduce the need for x rays in patients with acute knee injuries

doi:10.1136/ebm.9.5.151

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	EBM Diagnosis

Evidence-Based Medicine 2004; 9:151
© 2004 BMJ Publishing Group Ltd.

Diagnosis

Review: the Ottawa knee rule accurately rules out knee fractures and can substantially reduce the need for x rays in patients with acute knee injuries

Bachmann LM, Haberzeth S, Steurer J, et al. The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review. Ann Intern Med 2004;140:121–4.[Abstract/Free Full Text]

Q In patients with acute knee injuries, is the Ottawa knee rule (OKR) accurate for ruling out knee fractures?

Clinical impact ratings GP/FP/Primary care $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$ Emergency medicine $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$ IM/Ambulatory care $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$

Key Words: fractures • knee injuries

The first 150 words of the full text of this article appear below.

METHODS
Data sources: Medline and PreMedline (1966 to January 2003), CINAHL (1982–2003),EMBASE/Excerpta Medica (1980–2003), Biosis (1990–2003),the Cochrane Library (2002), and the Science Citation Indexdatabase; reference lists; and experts.

Study selection and assessment: studies in any language that assessed the OKR, investigatedfractures confirmed radiographically or in combination withfollow up; and reported enough information to calculate sensitivity,specificity, and likelihood ratios. Study quality was rankedas high quality (level 1 = consecutive patient enrolment,reference standard test done on all patients, radiographic assessmentof fracture done blinded to the results of the OKR); intermediatequality (level 2 = met 2 of the 3 level 1 criteria); low quality(level 3 = met 1 of the level 1 criteria); or very low quality(level 4 = met none of the level 1 criteria).

Outcomes: sensitivities, specificities, and likelihood ratios.

MAIN RESULTS
11 studies met the selection criteria. Of 4929 adult patients. . . [Full text of this article]

Eddy S Lang, MDCM

SMBD Jewish General Hospital, McGill University
Montréal, Québec, Canada