Department of Surgery/Traumatology, Red Cross Hospital, Beverwijk, the Netherlands.
Am J Emerg Med. 2013 Apr;31(4):641-5. doi: 10.1016/j.ajem.2012.11.003. Epub 2013 Feb 8.
The aim of this present study was to compare the diagnostic accuracy and reproducibility of 2 clinical decision rules (the Ottawa Knee Rules [OKR] and Pittsburgh Decision Rules [PDR]) developed for selective use of x-rays in the evaluation of isolated knee trauma. Application of a decision rule leads to a more efficient evaluation of knee injuries and a reduction in health care costs. The diagnostic accuracy and reproducibility are compared in this study.
A cross-sectional interobserver study was conducted in the emergency department of an urban teaching hospital from October 2008 to July 2009. Two observer groups collected data on standardized case-report forms: emergency medicine residents and surgical residents. Standard knee radiographs were performed in each patient. Participants were patients 18 years and older with isolated knee injuries. Pooled sensitivity and specificity were compared using χ(2) statistics, and interobserver agreement was calculated by using κ statistics.
Ninety injuries were assessed. Seven injuries concerned fractures (7.8%). For the OKR, the pooled sensitivity and specificity were 0.86 (95% confidence interval [CI], 0.57-0.96) and 0.27 (95% CI, 0.21-0.35), respectively. The PDR had a pooled sensitivity and specificity of 0.86 (95% CI, 0.57-0.96) and 0.51 (95% CI, 0.44-0.59). The PDR was significantly (P = .002) more specific. The κ values for the OKR and PDR were 0.51 (95% CI, 0.32-0.71) and 0.71 (95% CI, 0.57-0.86), respectively.
The PDR was found to be more specific than the OKR, with equal sensitivity. Interobserver agreement was moderate for the OKR and substantial for the PDR.
本研究旨在比较两种临床决策规则（渥太华膝关节规则[OKR]和匹兹堡决策规则[PDR]）在选择性使用 X 射线评估膝关节创伤中的诊断准确性和可重复性。应用决策规则可更有效地评估膝关节损伤并降低医疗保健成本。本研究比较了诊断准确性和可重复性。
本研究为 2008 年 10 月至 2009 年 7 月在城市教学医院的急诊科进行的一项横断面观察者间研究。两个观察者组在标准化病例报告表上收集数据：急诊医学住院医师和外科住院医师。对每位患者进行标准膝关节 X 光检查。参与者为 18 岁及以上的膝关节损伤患者。使用 χ(2)统计比较合并敏感性和特异性，使用 κ 统计计算观察者间一致性。
评估了 90 例损伤。7 例为骨折（7.8%）。对于 OKR，合并敏感性和特异性分别为 0.86（95%置信区间[CI]，0.57-0.96）和 0.27（95% CI，0.21-0.35）。PDR 的合并敏感性和特异性分别为 0.86（95% CI，0.57-0.96）和 0.51（95% CI，0.44-0.59）。PDR 明显（P=0.002）更特异。OKR 和 PDR 的κ 值分别为 0.51（95% CI，0.32-0.71）和 0.71（95% CI，0.57-0.86）。
与 OKR 相比，PDR 具有更高的特异性，而敏感性相等。OKR 的观察者间一致性为中度，而 PDR 的一致性为高度。
