Clinical criteria for using radiography for children with acute knee injuries.
OBJECTIVE
To evaluate clinical criteria for selective radiography for knee injuries in children.


METHODS
Retrospective chart review.


METHODS
Emergency department (ED) of a children's hospital.


METHODS
All patients evaluated by radiography for an isolated, acute knee injury during 12 months. Patients were excluded for injuries: >1 week; isolated to superficial lacerations/abrasions; with prior knee surgery; being reassessed.


RESULTS
Two hundred fifty-four patients (60% male; 12.7 years median age) were included. Twelve patients (4.7%) sustained a fracture. Evaluated criteria were point tenderness, inability to bear weight in the ED, and inability to flex the knee to 90 degrees. Point tenderness was not statistically associated with fracture, P = 0.7. Inability to bear weight in the ED (37% fracture rate, P = 0.001) and inability to flex to 90 degrees (52% fracture rate, P < 0.001) were associated with the presence of fracture.[table in text] Applying a rule combining nobearwt and noflex90 would decrease the number of x-rays by 73%, with no missed fractures.


CONCLUSIONS
Point tenderness was not a good predictor of knee fracture in children. Using the clinical criteria to select patients requiring knee radiography may greatly reduce the number of unnecessary x-rays.
Cohen
D M
DM
Department of Pediatrics, Ohio State University College of Medicine, Children's Hospital, Columbus 43205-2696, USA.
Jasser
J W
JW
Kean
J R
JR
Smith
G A
GA
D000208:Acute Disease; D002648:Child; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging; D006801:Humans; D007718:Knee Injuries / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D018579:Patient Selection; D011859:Radiography / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016474:Weight-Bearing