Szucs P A, Richman P B, Mandell M
Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, NJ 07962, USA.
Acad Emerg Med. 2001 Feb;8(2):112-6. doi: 10.1111/j.1553-2712.2001.tb01274.x.
To determine interobserver agreement between triage registered nurses (RNs) and emergency physicians (EPs) regarding indication for knee radiographs by applying the Ottawa knee rule (OKR) and individual components of the rule.
This was a prospective, observational study in a suburban, teaching emergency department. The study enrolled a convenience sample of patients aged >17 years with traumatic knee injuries less than one week old. Patients with prior knee surgery or distracting conditions were excluded. Before study initiation, the RNs and EPs were in-serviced in the OKR. Nurses and EPs independently examined each patient for OKR criteria, blinded to the other's assessment. Knee radiographs were ordered at the discretion of the EP and were interpreted by board-certified radiologists. All patients received follow-up with a structured telephone interview to identify any undetected fractures. Kappa was calculated for each component and the overall application of the OKR to assess interobserver agreement.
Ninety-six patients were enrolled. The mean age was 39.6 +/- 18.7 years; 50% were male. Eight patients (8%) had knee fractures. Interobserver agreements between the RNs and EPs for individual components of the OKR were: age > or =55 years (kappa = 0.97); inability to weight bear (kappa = 0.51); inability to bend knee to 90 degrees (kappa = 0.52); fibular head tenderness (kappa = 0.45); and isolated patellar tenderness (kappa = 0.40). The EPs and RNs agreed with OKR criteria for x-ray 71% of the time (kappa = 0.41).
The only criterion that resulted in almost perfect agreement between the RNs and EPs was patient age; agreement for the other four criteria and the overall decision to order x-rays was moderate.
通过应用渥太华膝关节规则（OKR）及其各个组成部分，确定分诊注册护士（RN）和急诊医生（EP）之间在膝关节X线检查指征方面的观察者间一致性。
这是一项在郊区教学急诊科进行的前瞻性观察性研究。该研究纳入了年龄大于17岁、膝关节创伤小于1周的患者的便利样本。排除既往有膝关节手术史或存在干扰情况的患者。在研究开始前，对RN和EP进行了OKR培训。护士和EP独立检查每位患者是否符合OKR标准，且对彼此的评估不知情。膝关节X线检查由EP酌情安排，并由具有委员会认证的放射科医生进行解读。所有患者均接受结构化电话随访，以确定是否有未被发现的骨折。计算每个组成部分以及OKR整体应用的kappa值，以评估观察者间一致性。
共纳入96例患者。平均年龄为39.6±18.7岁；50%为男性。8例患者（8%）有膝关节骨折。RN和EP在OKR各个组成部分的观察者间一致性为：年龄≥55岁（kappa = 0.97）；无法负重（kappa = 0.51）；无法将膝关节弯曲至90度（kappa = 0.52）；腓骨头压痛（kappa = 0.45）；以及孤立的髌骨压痛（kappa = 0.40）。EP和RN在71% 的情况下对OKR的X线检查标准达成一致（kappa = 0.41）。
导致RN和EP之间几乎完全一致的唯一标准是患者年龄；对于其他四个标准以及进行X线检查的总体决策，一致性为中等。
