• Lucas M Bachmann, Sophie Haberzeth, Johann Steurer, and Gerben ter Riet.
• Horten Centre, Zurich University, Zurich, Switzerland. lucas.bachmann@evimed.ch
• Ann. Intern. Med. 2004 Jan 20; 140 (2): 121124121-4.

BackgroundThe Ottawa knee rule is a clinical decision aid that helps rule out fractures and avoid unnecessary radiography.PurposeTo summarize evidence about the accuracy of the Ottawa knee rule.Data SourcesRelevant English- and non-English-language articles were identified from PreMEDLINE and MEDLINE (1966-2003), EMBASE (1980-2003), CINAHL (1982-2003), BIOSIS (1990-2003), the Cochrane Library (2002, Issue 3), the Science Citation Index database, reference lists of included studies, and experts.Study SelectionArticles were included if they reported enough information to determine the sensitivity and specificity of the Ottawa knee rule for detecting fractures confirmed either radiologically or in combination with follow-up.Data ExtractionTwo reviewers independently extracted data on study samples, the ways that the Ottawa knee rule was used, and methodologic characteristics of studies.Data SynthesisOf 11 identified studies, 6 involving 4249 adult patients were considered appropriate for pooled analysis. The pooled negative likelihood ratio was 0.05 (95% CI, 0.02 to 0.23), the pooled sensitivity was 98.5% (CI, 93.2% to 100%), and the pooled specificity was 48.6% (CI, 43.4% to 51.0%).ConclusionA negative result on an Ottawa knee rule test accurately excluded knee fractures after acute knee injury. However, because the rule is calibrated toward 100% sensitivity and actual fracture prevalences are usually low, large-scale, multicentered studies are still needed to establish the cost-effectiveness of routinely implementing the rule.

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