The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review.
BACKGROUND
The Ottawa knee rule is a clinical decision aid that helps rule out fractures and avoid unnecessary radiography.


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


METHODS
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.


METHODS
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.


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


RESULTS
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%).


CONCLUSIONS
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.
Bachmann
Lucas M
LM
Horten Centre, Zurich University, Zurich, Switzerland. lucas.bachmann@evimed.ch
Haberzeth
Sophie
S
Steurer
Johann
J
ter Riet
Gerben
G
D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D050723:Fractures, Bone / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D015601:Injury Severity Score; D007718:Knee Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011859:Radiography / Q000706:statistics & numerical data