Applicability of Ottawa knee rule for knee injury in children

Hnin Khine, David H. Dorfman, Jeffrey R. Avner

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: Previous studies have shown that the application of the Ottawa knee rule (OKR) reduces the need for radiographs in adults with acute knee injuries. Our objectives were to describe the epidemiology and incidence of knee injuries in children with acute knee trauma and to validate the OKR in a pediatric population. Design: A prospective, consecutive study. Settings: Two urban pediatric emergency departments. Methods: All children 18 years of age and under who presented with acute traumatic knee injury of less than 1 week's duration, excluding patients with a normal knee examination, superficial skin injuries, prior history of knee injury, underlying bone disease, serious injuries involving two or more organ systems, or altered mental status were enrolled. Physicians assessed each patient for 22 standardized clinical findings prior to radiography. The OKR was applied to each patient by the investigating physician. Results: All 234 patients eligible for the study had radiographs of the affected knee. The median age was 13 years with a range of 2 to 18 years. Using the OKR criteria for obtaining knee radiographs, 12 of 13 patients with fractures were identified (sensitivity 92%; 95% CI = 64-99). The missed case was an 8-year-old male who had sustained a nondisplaced fracture of the proximal tibia after a fall. If the OKR were applied to the pediatric population, it would have reduced the need for radiography in 46% of children. Conclusions: In the pediatric population studied, the OKR did not identify all patients with knee fractures. Future studies may consider modifying the OKR to accommodate the differences between pediatric and adult patients to improve the sensitivity of the rule while maintaining its specificity, before it can be applied routinely in clinical practice.

Original languageEnglish (US)
Pages (from-to)401-404
Number of pages4
JournalPediatric Emergency Care
Volume17
Issue number6
DOIs
StatePublished - 2001

Fingerprint

Knee Injuries
Knee
Pediatrics
Radiography
Wounds and Injuries
Population
Physicians
Bone Diseases
Tibia
Hospital Emergency Service
Epidemiology

Keywords

  • Knee injury
  • Ottawa knee rule

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nursing(all)
  • Emergency Medicine

Cite this

Applicability of Ottawa knee rule for knee injury in children. / Khine, Hnin; Dorfman, David H.; Avner, Jeffrey R.

In: Pediatric Emergency Care, Vol. 17, No. 6, 2001, p. 401-404.

Research output: Contribution to journalArticle

Khine, Hnin ; Dorfman, David H. ; Avner, Jeffrey R. / Applicability of Ottawa knee rule for knee injury in children. In: Pediatric Emergency Care. 2001 ; Vol. 17, No. 6. pp. 401-404.
@article{d0416dfc1ef34cbcbd267f4af3e193a5,
title = "Applicability of Ottawa knee rule for knee injury in children",
abstract = "Objective: Previous studies have shown that the application of the Ottawa knee rule (OKR) reduces the need for radiographs in adults with acute knee injuries. Our objectives were to describe the epidemiology and incidence of knee injuries in children with acute knee trauma and to validate the OKR in a pediatric population. Design: A prospective, consecutive study. Settings: Two urban pediatric emergency departments. Methods: All children 18 years of age and under who presented with acute traumatic knee injury of less than 1 week's duration, excluding patients with a normal knee examination, superficial skin injuries, prior history of knee injury, underlying bone disease, serious injuries involving two or more organ systems, or altered mental status were enrolled. Physicians assessed each patient for 22 standardized clinical findings prior to radiography. The OKR was applied to each patient by the investigating physician. Results: All 234 patients eligible for the study had radiographs of the affected knee. The median age was 13 years with a range of 2 to 18 years. Using the OKR criteria for obtaining knee radiographs, 12 of 13 patients with fractures were identified (sensitivity 92{\%}; 95{\%} CI = 64-99). The missed case was an 8-year-old male who had sustained a nondisplaced fracture of the proximal tibia after a fall. If the OKR were applied to the pediatric population, it would have reduced the need for radiography in 46{\%} of children. Conclusions: In the pediatric population studied, the OKR did not identify all patients with knee fractures. Future studies may consider modifying the OKR to accommodate the differences between pediatric and adult patients to improve the sensitivity of the rule while maintaining its specificity, before it can be applied routinely in clinical practice.",
keywords = "Knee injury, Ottawa knee rule",
author = "Hnin Khine and Dorfman, {David H.} and Avner, {Jeffrey R.}",
year = "2001",
doi = "10.1097/00006565-200112000-00001",
language = "English (US)",
volume = "17",
pages = "401--404",
journal = "Pediatric Emergency Care",
issn = "0749-5161",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Applicability of Ottawa knee rule for knee injury in children

AU - Khine, Hnin

AU - Dorfman, David H.

AU - Avner, Jeffrey R.

PY - 2001

Y1 - 2001

N2 - Objective: Previous studies have shown that the application of the Ottawa knee rule (OKR) reduces the need for radiographs in adults with acute knee injuries. Our objectives were to describe the epidemiology and incidence of knee injuries in children with acute knee trauma and to validate the OKR in a pediatric population. Design: A prospective, consecutive study. Settings: Two urban pediatric emergency departments. Methods: All children 18 years of age and under who presented with acute traumatic knee injury of less than 1 week's duration, excluding patients with a normal knee examination, superficial skin injuries, prior history of knee injury, underlying bone disease, serious injuries involving two or more organ systems, or altered mental status were enrolled. Physicians assessed each patient for 22 standardized clinical findings prior to radiography. The OKR was applied to each patient by the investigating physician. Results: All 234 patients eligible for the study had radiographs of the affected knee. The median age was 13 years with a range of 2 to 18 years. Using the OKR criteria for obtaining knee radiographs, 12 of 13 patients with fractures were identified (sensitivity 92%; 95% CI = 64-99). The missed case was an 8-year-old male who had sustained a nondisplaced fracture of the proximal tibia after a fall. If the OKR were applied to the pediatric population, it would have reduced the need for radiography in 46% of children. Conclusions: In the pediatric population studied, the OKR did not identify all patients with knee fractures. Future studies may consider modifying the OKR to accommodate the differences between pediatric and adult patients to improve the sensitivity of the rule while maintaining its specificity, before it can be applied routinely in clinical practice.

AB - Objective: Previous studies have shown that the application of the Ottawa knee rule (OKR) reduces the need for radiographs in adults with acute knee injuries. Our objectives were to describe the epidemiology and incidence of knee injuries in children with acute knee trauma and to validate the OKR in a pediatric population. Design: A prospective, consecutive study. Settings: Two urban pediatric emergency departments. Methods: All children 18 years of age and under who presented with acute traumatic knee injury of less than 1 week's duration, excluding patients with a normal knee examination, superficial skin injuries, prior history of knee injury, underlying bone disease, serious injuries involving two or more organ systems, or altered mental status were enrolled. Physicians assessed each patient for 22 standardized clinical findings prior to radiography. The OKR was applied to each patient by the investigating physician. Results: All 234 patients eligible for the study had radiographs of the affected knee. The median age was 13 years with a range of 2 to 18 years. Using the OKR criteria for obtaining knee radiographs, 12 of 13 patients with fractures were identified (sensitivity 92%; 95% CI = 64-99). The missed case was an 8-year-old male who had sustained a nondisplaced fracture of the proximal tibia after a fall. If the OKR were applied to the pediatric population, it would have reduced the need for radiography in 46% of children. Conclusions: In the pediatric population studied, the OKR did not identify all patients with knee fractures. Future studies may consider modifying the OKR to accommodate the differences between pediatric and adult patients to improve the sensitivity of the rule while maintaining its specificity, before it can be applied routinely in clinical practice.

KW - Knee injury

KW - Ottawa knee rule

UR - http://www.scopus.com/inward/record.url?scp=0035687061&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035687061&partnerID=8YFLogxK

U2 - 10.1097/00006565-200112000-00001

DO - 10.1097/00006565-200112000-00001

M3 - Article

C2 - 11753181

AN - SCOPUS:0035687061

VL - 17

SP - 401

EP - 404

JO - Pediatric Emergency Care

JF - Pediatric Emergency Care

SN - 0749-5161

IS - 6

ER -