Validation of the Ottawa Knee Rule in children: a multicenter study

Blake Bulloch, Gina Neto, Amy Plint, Rodrick Lim, Per Lidman, Martin Reed, Cheri Nijssen-Jordan, Milton Tenenbein, Terry P Klassen, Ravi Bhargava
Annals of Emergency Medicine 2003, 42 (1): 48-55

STUDY OBJECTIVE: The main objective of this study was to determine the sensitivity and specificity of the Ottawa Knee Rules when they were applied to children. The secondary objective was to determine post hoc whether use of the rules would reduce the number of knee radiographs ordered.

METHODS: This prospective, multicenter validation study included children aged 2 to 16 years who presented to the emergency department with a knee injury sustained in the preceding 7 days. Children were assessed for the variables comprising the Ottawa Knee Rules, and physicians ordered radiographs at their discretion. A positive outcome was defined as any fracture. A negative outcome was defined as children who did not have a fracture on radiograph or, if no radiograph was obtained, were asymptomatic after 14 days.

RESULTS: A total of 750 children were enrolled. The mean age was 11.8+/-3.1 years, and 443 (58.7%) were male patients. Seventy children had fractures. Radiography was performed for 670 children, whereas 80 children had only a structured telephone interview. The Ottawa Knee Rules were 100% sensitive (95% confidence interval [CI] 94.9% to 100%), with a specificity of 42.8% (95% CI 39.1% to 46.5%). Only 460 children would have required a radiograph if radiographs had been performed according to the Ottawa Knee Rules, which would have resulted in an absolute reduction of 209 (31.2%) radiographs.

CONCLUSION: The Ottawa Knee Rules are valid in children and have the potential to decrease the use of radiography in children with knee injuries.

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