Derivation of a Decision Rule for the Use of Radiography in Acute Knee Injuries

摘要: 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 two university hospitals. Participants: Convenience sample 1,047 adults with Results: Attending emergency physicians assessed each patient 23 standardized clinical findings, which were recorded on data collection forms. A total 127 patients was examined independently by to determine interobserver agreement. The outcome measure fracture knee. Any who did not have ED underwent structured telephone interview possibility missed fracture. Those variables found be both reliable (highest k values) and strongly associated χ 2 further analyzed recursive-partitioning multivariate technique. derived included following variables: (1) age 55 years or older, (2) tenderness at head fibula, (3) isolated patella, (4) inability flex 90 degrees, (5) bear weight immediately (four steps). presence one more these findings would identified 68 fractures study population sensitivity 1.0 (95% confidence interval [CI], .95 1.0) specificity .54 CI, .51 .57). Application led 28.0% relative reduction from 68.6% 49.4% population. Conclusion: practical, sensitive, injuries has been derived. Clinical application should await prospective validation rule. [Stiell IG, Greenberg GH, Wells GA, McKnight RD, Cwinn AA, Cacciotti T, McDowell I, Smith NA: Derivation Ann Emerg Med October 1995;26:405-413.]