School of Health Sciences, University of South Australia, 108 North Terrace, Adelaide, South Australia, Australia.
Medical Imaging Department, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia.
Eur Radiol. 2020 Aug;30(8):4438-4446. doi: 10.1007/s00330-020-06804-x. Epub 2020 Mar 28.
This systematic review and meta-analysis aimed to evaluate the current evidence on the diagnostic accuracy of the Ottawa Knee Rule (OKR) for acute knee injuries in adults.
A literature search of Embase (Elsevier), MEDLINE (U.S. National Library of Medicine), PubMed and Scopus databases (1995 to date; English language) was performed and the relevant references were assessed. Original articles documenting OKR use by emergency physicians to assess adult acute knee injuries were included. Study methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Results of eligible studies were pooled using random effects or fixed effects modelling to calculate the diagnostic performance of the OKR. The Higgins I test and Begg's association test were performed to assess between-study heterogeneity and publication bias respectively, with Spearman's correlation test for threshold effect.
Eight studies, including 7385 patients, were enrolled and pooled using the random effects model. Sensitivity, specificity, negative likelihood ratio, positive likelihood ratio and diagnostic odds ratio were 0.99 (95% CI, 0.97 to 1.00), 0.49 (95% CI, 0.47 to 0.51), 0.07 (95% CI, 0.02 to 0.24), 1.86 (95% CI, 1.72 to 2.01) and 25.10 (95% CI, 7.18 to 87.70) respectively. Based on the QUADAS-2 criteria, most studies presented low risk of bias and concern regarding applicability.
Application of the OKR can rule out knee fracture and thus avoid unnecessary radiography. These results also translate to improved efficiency, lower medical costs and reduced waiting times.
• The Ottawa Knee Rule helps clinicians to rule out fracture in adults with an acute knee injury. • The rule allows a reduction in radiography requests, patient waiting time in the emergency department and healthcare costs.
本系统评价和荟萃分析旨在评估奥塔哥膝关节规则（OKR）在评估成人急性膝关节损伤方面的当前证据。
对 Embase（爱思唯尔）、MEDLINE（美国国立医学图书馆）、PubMed 和 Scopus 数据库（1995 年至今；英文）进行文献检索，并评估了相关参考文献。纳入了记录急诊医师使用 OKR 评估成人急性膝关节损伤的原始文章。使用 QUADAS-2 工具评估研究的方法学质量。使用随机效应或固定效应模型汇总合格研究的结果，以计算 OKR 的诊断性能。使用 Higgins I 检验和 Begg 关联检验分别评估研究间异质性和发表偏倚，使用 Spearman 相关检验评估阈值效应。
纳入了 8 项研究，共 7385 例患者，使用随机效应模型进行汇总。敏感性、特异性、阴性似然比、阳性似然比和诊断优势比分别为 0.99（95%置信区间，0.97 至 1.00）、0.49（95%置信区间，0.47 至 0.51）、0.07（95%置信区间，0.02 至 0.24）、1.86（95%置信区间，1.72 至 2.01）和 25.10（95%置信区间，7.18 至 87.70）。根据 QUADAS-2 标准，大多数研究的偏倚风险和适用性问题较低。
应用 OKR 可以排除膝关节骨折，从而避免不必要的 X 线摄影。这些结果还可以提高效率，降低医疗成本和减少患者在急诊室的等待时间。
• 奥塔哥膝关节规则有助于临床医生排除急性膝关节损伤的成人骨折。• 该规则可减少 X 线摄影请求、患者在急诊室的等待时间和医疗保健成本。
