Format

Send to

Choose Destination
See comment in PubMed Commons below
Ann Intern Med. 2004 Jan 20;140(2):121-4.

The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review.

Author information

1
Horten Centre, Zurich University, Zurich, Switzerland. lucas.bachmann@evimed.ch

Abstract

BACKGROUND:

The Ottawa knee rule is a clinical decision aid that helps rule out fractures and avoid unnecessary radiography.

PURPOSE:

To summarize evidence about the accuracy of the Ottawa knee rule.

DATA SOURCES:

Relevant English- and non-English-language articles were identified from PreMEDLINE and MEDLINE (1966-2003), EMBASE (1980-2003), CINAHL (1982-2003), BIOSIS (1990-2003), the Cochrane Library (2002, Issue 3), the Science Citation Index database, reference lists of included studies, and experts.

STUDY SELECTION:

Articles were included if they reported enough information to determine the sensitivity and specificity of the Ottawa knee rule for detecting fractures confirmed either radiologically or in combination with follow-up.

DATA EXTRACTION:

Two reviewers independently extracted data on study samples, the ways that the Ottawa knee rule was used, and methodologic characteristics of studies.

DATA SYNTHESIS:

Of 11 identified studies, 6 involving 4249 adult patients were considered appropriate for pooled analysis. The pooled negative likelihood ratio was 0.05 (95% CI, 0.02 to 0.23), the pooled sensitivity was 98.5% (CI, 93.2% to 100%), and the pooled specificity was 48.6% (CI, 43.4% to 51.0%).

CONCLUSION:

A negative result on an Ottawa knee rule test accurately excluded knee fractures after acute knee injury. However, because the rule is calibrated toward 100% sensitivity and actual fracture prevalences are usually low, large-scale, multicentered studies are still needed to establish the cost-effectiveness of routinely implementing the rule.

PMID:
14734335
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems Icon for PubMed Health
    Loading ...
    Support Center