title: The use of history to identify anterior cruciate ligament injuries in the acute trauma setting: the 'LIMP index'.
abstract: OBJECTIVE
  To identify the injury history features reported by patients with anterior cruciate ligament (ACL) injuries and determine whether history may be used to identify patients requiring follow-up appointments from acute trauma services.
  
  
  METHODS
  Multisite cross-sectional service evaluation using a survey questionnaire design conducted in the UK. The four injury history features investigated were 'leg giving way at the time of injury', 'inability to continue activity immediately following injury', 'marked effusion' and 'pop (heard or felt) at the time of injury'(LIMP).
  
  
  RESULTS
  194 patients with ACL injury were identified, of which 165 (85.5%) attended an acute trauma service. Data on delay was available for 163 (98.8%) of these patients of which 120 (73.6%) had a follow-up appointment arranged. Patients who had a follow-up appointment arranged waited significantly less time for a correct diagnosis (geometric mean 29 vs 198 days; p<0.001) and to see a specialist consultant (geometric mean 61 vs 328 days; p<0.001). Using a referral threshold of any two of the four LIMP injury history features investigated, 95.8% of patients would have had a follow-up appointment arranged.
  
  
  CONCLUSIONS
  Findings support the value of questioning patients on specific injury history features in identifying patients who may have suffered ACL injury. Using a threshold of two or more of the four LIMP history features investigated would have reduced the percentage of patients inappropriately discharged by 22.2%. Evidence presented suggests that this would significantly reduce the time to diagnosis and specialist consultation minimising the chance of secondary complications.
authors.affiliation: Faculty of Health Studies, University of Bradford, Bradford, UK c.a.ayre1@bradford.ac.uk.|Department of Orthopaedics, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Ayre
authors.affiliation: Faculty of Health Studies, University of Bradford, Bradford, UK.
authors.forename: Maryann
authors.initials: M
authors.lastname: Hardy
authors.affiliation: Faculty of Health Studies, University of Bradford, Bradford, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Scally
authors.affiliation: Department of Orthopaedics, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Radcliffe
authors.affiliation: Department of Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Ram
authors.initials: R
authors.lastname: Venkatesh
authors.affiliation: Department of Orthopaedics, Mid Yorkshire Hospitals NHS Trust, Dewsbury, UK.
authors.forename: Jon
authors.initials: J
authors.lastname: Smith
authors.affiliation: Department of Orthopaedics, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Guy
mesh_terms: D000328:Adult; D000359:Aftercare / Q000706:statistics & numerical data; D016118:Anterior Cruciate Ligament / Q000002:abnormalities / Q000503:physiopathology; D000070598:Anterior Cruciate Ligament Injuries / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013222:State Medicine / Q000458:organization & administration; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014947:Wounds and Injuries / Q000175:diagnosis*
keywords: Anterior cruciate ligament injuries/ diagnosis; Clinical examination.; Delayed diagnosis; History taking; Knee injuries/diagnosis