Template:Special Test: Difference between revisions

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'''5.'''  ''Inability to bear weight both immediately and in the emergency department for 4 steps  (unable to transfer weight twice on  each lower limb regardless of limping)''
'''5.'''  ''Inability to bear weight both immediately and in the emergency department for 4 steps  (unable to transfer weight twice on  each lower limb regardless of limping)''


== Evidence<br> ==
== Evidence<ref>Stiell IG, Greenberg GH, Wells GA, McDowell I, Cwinn A, Smith NA, Cacciotti TF, Marco LA. Prospective validation of a Decision Rule for the use of Radiography in Acute Knee Injuries. JAMA. 1996;275:611-615</ref><br> ==
 
&nbsp; An estimated 1.3 million patients are seen annually in US emergency departments with acute knee trauma.<ref name="McCaig">McCaig LF. national Hospital Ambulatory Medial Care Survey: 1992 emergency department summary. Advance Data. 1994;245:1-12.</ref><ref>National Center for Health Statistics. National Hospital AmbulatoryMedical Care Survey 1992. Hyattsville, MD:National Center for Health Statistics; 1994.</ref>&nbsp; Although only 6% of these patients have suffered a fracture, the vast majority undergo plain radiography of the knee.<ref>Naational Center for Health Statistics. National Hospital Ambulatory Medical Care Survey 1992. Hyattsville, MD:National Center for health Statistics; 1994.</ref><ref name="Steill et al">Stiell IG, Wells GA, McDowell I, et al. Use of Radiography in acute knee injuries: need for clinical decision rules. Acad Emerg Med. 1995;2:966-973.</ref><ref name="Gleadhill et al">Gleadhill DNS, Thomson JY, Simms P. Can more efficient use be made of x-ray examinations in the accident and emergency department? BMJ. 1987;294;943-947.</ref><ref name="Gratton et al">Gratton MC, Salomone JA III, Watson WA. Clinically Significant radiograph misinterpretationsat an emergency medicine residency program. Ann Emerg Med. 1990;19:497-502.</ref><ref>McConnochie KM, Roghmann KJ, Pasternack J, Monroe DJ, Monaco LP. Prediction rules for selective radiographic assessment of extremity injuriesin children and adolescents. Pediatrics. 1990;86:45-57.</ref>&nbsp; More than 92% of these radiographic results are negative for fractures and exemplify the many low cost,&nbsp;but high volume tests that add to health care costs.<ref name="Moloney et al">Moloney TW, Rogers DE. Medical Technology: a different viewof the contentious debate over costs. N Eng J Med. 1979;301:1413-1419.</ref><ref name="Angell">Angell M. Cost containment and the physician. JAMA. 1985;254:1203-1207.</ref>&nbsp; The Ottawa knee&nbsp;decision rule was developed in an attempt to allow physicians to be more selective&nbsp;with radiography, without&nbsp;missing clinically important fractures.<ref name="Steill IG">Stiell IG, Greenberg GH, Wells GA, et al. Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med. 1995;26:405-413.</ref>&nbsp;&nbsp; A&nbsp;prospective study by Stiell, et al (1996),&nbsp;have found the rules to be 100% sensitive&nbsp;for identifying fractures of the knee&nbsp;with the potential relative reduction in the use of&nbsp;radiography to be estimated at 28%.&nbsp;


== Resources  ==
== Resources  ==

Revision as of 07:33, 20 November 2009

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Purpose
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   A decision rule used to determine the need for radiographs in acute knee injuries.

Technique
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  The decision rule is applied to any patient presenting with an acute knee injury.  If any of the 5 following findings are present, the patient should have radiographic examination.

1.  Age 55 or older

2.  Isolated tenderness of the patella (no bone tenderness of knee other than patella)

3.  Tenderness of the head of the fibula

4.  Inability to flex to 90 degrees

5.  Inability to bear weight both immediately and in the emergency department for 4 steps  (unable to transfer weight twice on  each lower limb regardless of limping)

Evidence[1]
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  An estimated 1.3 million patients are seen annually in US emergency departments with acute knee trauma.[2][3]  Although only 6% of these patients have suffered a fracture, the vast majority undergo plain radiography of the knee.[4][5][6][7][8]  More than 92% of these radiographic results are negative for fractures and exemplify the many low cost, but high volume tests that add to health care costs.[9][10]  The Ottawa knee decision rule was developed in an attempt to allow physicians to be more selective with radiography, without missing clinically important fractures.[11]   A prospective study by Stiell, et al (1996), have found the rules to be 100% sensitive for identifying fractures of the knee with the potential relative reduction in the use of radiography to be estimated at 28%. 

Resources[edit source]

Ottawa Hospital Research Institute

Recent Related Research (from Pubmed)[edit source]

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References[edit source]

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  1. ↑ Stiell IG, Greenberg GH, Wells GA, McDowell I, Cwinn A, Smith NA, Cacciotti TF, Marco LA. Prospective validation of a Decision Rule for the use of Radiography in Acute Knee Injuries. JAMA. 1996;275:611-615
  2. ↑ McCaig LF. national Hospital Ambulatory Medial Care Survey: 1992 emergency department summary. Advance Data. 1994;245:1-12.
  3. ↑ National Center for Health Statistics. National Hospital AmbulatoryMedical Care Survey 1992. Hyattsville, MD:National Center for Health Statistics; 1994.
  4. ↑ Naational Center for Health Statistics. National Hospital Ambulatory Medical Care Survey 1992. Hyattsville, MD:National Center for health Statistics; 1994.
  5. ↑ Stiell IG, Wells GA, McDowell I, et al. Use of Radiography in acute knee injuries: need for clinical decision rules. Acad Emerg Med. 1995;2:966-973.
  6. ↑ Gleadhill DNS, Thomson JY, Simms P. Can more efficient use be made of x-ray examinations in the accident and emergency department? BMJ. 1987;294;943-947.
  7. ↑ Gratton MC, Salomone JA III, Watson WA. Clinically Significant radiograph misinterpretationsat an emergency medicine residency program. Ann Emerg Med. 1990;19:497-502.
  8. ↑ McConnochie KM, Roghmann KJ, Pasternack J, Monroe DJ, Monaco LP. Prediction rules for selective radiographic assessment of extremity injuriesin children and adolescents. Pediatrics. 1990;86:45-57.
  9. ↑ Moloney TW, Rogers DE. Medical Technology: a different viewof the contentious debate over costs. N Eng J Med. 1979;301:1413-1419.
  10. ↑ Angell M. Cost containment and the physician. JAMA. 1985;254:1203-1207.
  11. ↑ Stiell IG, Greenberg GH, Wells GA, et al. Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med. 1995;26:405-413.


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