Khine H, Dorfman D H, Avner J R
Division of Pediatric Emergency Medicine, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA.
Pediatr Emerg Care. 2001 Dec;17(6):401-4. doi: 10.1097/00006565-200112000-00001.
Previous studies have shown that the application of the Ottawa knee rule (OKR) reduces the need for radiographs in adults with acute knee injuries. Our objectives were to describe the epidemiology and incidence of knee injuries in children with acute knee trauma and to validate the OKR in a pediatric population.
A prospective, consecutive study.
Two urban pediatric emergency departments.
All children 18 years of age and under who presented with acute traumatic knee injury of less than 1 week's duration, excluding patients with a normal knee examination, superficial skin injuries, prior history of knee injury, underlying bone disease, serious injuries involving two or more organ systems, or altered mental status were enrolled. Physicians assessed each patient for 22 standardized clinical findings prior to radiography. The OKR was applied to each patient by the investigating physician.
All 234 patients eligible for the study had radiographs of the affected knee. The median age was 13 years with a range of 2 to 18 years. Using the OKR criteria for obtaining knee radiographs, 12 of 13 patients with fractures were identified (sensitivity 92%; 95% CI= 64-99). The missed case was an 8-year-old male who had sustained a nondisplaced fracture of the proximal tibia after a fall. If the OKR were applied to the pediatric population, it would have reduced the need for radiography in 46% of children.
In the pediatric population studied, the OKR did not identify all patients with knee fractures. Future studies may consider modifying the OKR to accommodate the differences between pediatric and adult patients to improve the sensitivity of the rule while maintaining its specificity, before it can be applied routinely in clinical practice.
既往研究表明，渥太华膝关节规则（OKR）的应用减少了急性膝关节损伤成人患者的X线检查需求。我们的目的是描述急性膝关节创伤儿童的膝关节损伤流行病学和发病率，并在儿科人群中验证OKR。
一项前瞻性连续研究。
两个城市儿科急诊科。
纳入所有18岁及以下、急性创伤性膝关节损伤持续时间少于1周的儿童，排除膝关节检查正常、浅表皮肤损伤、既往膝关节损伤史、潜在骨病、涉及两个或更多器官系统的严重损伤或精神状态改变的患者。医生在进行X线检查前评估每位患者的22项标准化临床检查结果。研究医生对每位患者应用OKR。
所有234名符合研究条件的患者均对患侧膝关节进行了X线检查。中位年龄为13岁，范围为2至18岁。使用OKR标准进行膝关节X线检查，13例骨折患者中有12例被识别（敏感性92%；95%CI=64-99）。漏诊病例是一名8岁男性，跌倒后发生胫骨近端无移位骨折。如果将OKR应用于儿科人群，将减少46%儿童的X线检查需求。
在所研究的儿科人群中，OKR未能识别所有膝关节骨折患者。未来的研究可能需要考虑修改OKR，以适应儿科和成人患者之间的差异，在其能够常规应用于临床实践之前，提高该规则的敏感性同时保持其特异性。
