The Ottawa Knee Rules accurately identified fractures in children with knee injuries

摘要

Validity testing has shown that use of the OKR in adults can reduce the need for knee x rays without jeopardising clinical outcome.The study by Bulloch ef al examined the use of the OKR in assessing children's knee injuries. Of the 670 children x rayed after OKR assessment, 70 were found to have fractures. In every case, the need for x ray was identified by the OKR.The training of participating physicians in the use of the OKR, goori interobserver reliability testing, and blinding of x ray reviewers to OKR assessments add to the study's scientific merit. Of interest is the finding that only 209 of the 460 children would have required x rays if they hoc! been assessed using only the OKR, a reduction of 31%.Although these results are promising, the OKR should be used with caution when assessing children in the youngest age group studied. Some study sites were over-represented in the data, and only 45 of the 750 children were between 2-5 years of age. This, together with the fact that 34% of eligible children were not enrolled, limits the generalisability of the findings to all children.Bulloch ef al's claim that use of the OKR can safely reduce the necessiiy for knee x rays in children and lead to important healthcare savings seems to be true for children over 5 years. More research is needed about its diagnostic value in younger children. However, recent research has shown differences among emergency physicians in the US, Canada and the UK in terms of their knowledge and use of decision rules, such as the OKR.2 Therefore, additional work to determine factors that influence the adoption of clinical rules may be equally relevant.