• D Vijayasankar, A A Boyle, and P Atkinson.
• Peterborough District Hospital, Peterborough, UK.
• Emerg Med J. 2009 Apr 1;26(4):250-3.

BackgroundThe Ottawa knee rule (OKR), a clinical decision aid is used to reduce unnecessary radiography. It is not clear whether this rule can be applied to children.ObjectiveTo establish whether the OKR had adequate sensitivity and acceptable specificity in children to advocate widespread use.MethodsA systematic review and meta-analysis was conducted of observational studies that examined the diagnostic characteristics of the OKR in children.Data SourcesRelevant English language articles were identified from Medline (1950 to date), EMBASE (1974 to date), CINAHL (1982 to date), the Cochrane Library, Google Scholar and a hand search of bibliographies.Study SelectionObservational studies that included children and have used the OKR for ruling out fractures in children either radiologically or in combination with follow-up.ResultsFour relevant studies were identified. Three studies were suitable for inclusion in the meta-analysis, representing 1130 children. The pooled negative likelihood ratio was 0.07 (95% CI 0.02 to 0.29), the pooled positive likelihood ratio was 1.94 (95% CI 1.60 to 2.36), the pooled sensitivity was 99% (CI 94.4 to 99.8) and the pooled specificity was 46% (CI 43.0 to 49.1). The reduction in radiography was between 30% and 40%.ConclusionThe OKR has high sensitivity and adequate specificity for children over the age of 5 years. There are not enough good data to advocate application of the OKR in children less than 5 years.

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