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Derivation of a decision rule for the use of radiography in acute knee injuries.

Abstract：

STUDY OBJECTIVE:To derive a highly sensitive decision rule for the selective use of radiography in acute knee injuries. DESIGN:Prospectively administered survey. SETTING:Emergency departments of two university hospitals. PARTICIPANTS:Convenience sample of 1,047 adults with acute knee injuries. RESULTS:Attending emergency physicians assessed each patient for 23 standardized clinical findings, which were recorded on data collection forms. A total of 127 patients was examined independently by two physicians to determine interobserver agreement. The outcome measure was fracture of the knee. Any patients who did not have ED radiography underwent a structured telephone interview to determine the possibility of a missed fracture. Those variables found to be both reliable (highest kappa values) and strongly associated with a fracture (highest chi 2 values) were further analyzed by a recursive-partitioning multivariate technique. The derived decision rule included the following variables: (1) age 55 years or older, (2) tenderness at the head of the fibula, (3) isolated tenderness of the patella, (4) inability to flex to 90 degrees, and (5) inability to bear weight both immediately and in the ED (four steps). The presence of one or more of these findings would have identified the 68 fractures in the study population with a sensitivity of 1.0 (95% confidence interval [Cl], .95 to 1.0) and a specificity of .54 (95% Cl, .51 to .57). Application of the rule would have led to a 28.0% relative reduction in the use of radiography from 68.6% to 49.4% in the study population. CONCLUSION:A practical, highly sensitive, and reliable decision rule for the use of radiography in acute knee injuries has been derived. Clinical application should await prospective validation of the rule.

journal_name

Ann Emerg Med

journal_title

Annals of emergency medicine

authors

Stiell IG,Greenberg GH,Wells GA,McKnight RD,Cwinn AA,Cacciotti T,McDowell I,Smith NA

doi

10.1016/s0196-0644(95)70106-0

subject

Has Abstract

pub_date

1995-10-01 00:00:00

pages

405-13

issue

4

eissn

0196-0644

issn

1097-6760

pii

S0196-0644(95)70106-0

journal_volume

26

pub_type

杂志文章

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