Cohen D M, Jasser J W, Kean J R, Smith G A
Department of Pediatrics, Ohio State University College of Medicine, Children's Hospital, Columbus 43205-2696, USA.
Pediatr Emerg Care. 1998 Jun;14(3):185-7. doi: 10.1097/00006565-199806000-00002.
To evaluate clinical criteria for selective radiography for knee injuries in children.
Retrospective chart review.
Emergency department (ED) of a children's hospital.
All patients evaluated by radiography for an isolated, acute knee injury during 12 months. Patients were excluded for injuries: >1 week; isolated to superficial lacerations/abrasions; with prior knee surgery; being reassessed.
Two hundred fifty-four patients (60% male; 12.7 years median age) were included. Twelve patients (4.7%) sustained a fracture. Evaluated criteria were point tenderness, inability to bear weight in the ED, and inability to flex the knee to 90 degrees. Point tenderness was not statistically associated with fracture, P = 0.7. Inability to bear weight in the ED (37% fracture rate, P = 0.001) and inability to flex to 90 degrees (52% fracture rate, P < 0.001) were associated with the presence of fracture.[table in text] Applying a rule combining nobearwt and noflex90 would decrease the number of x-rays by 73%, with no missed fractures.
Point tenderness was not a good predictor of knee fracture in children. Using the clinical criteria to select patients requiring knee radiography may greatly reduce the number of unnecessary x-rays.
