• J E Weber, R E Jackson, W F Peacock, R A Swor, R Carley, and G L Larkin.
• Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA.
• Ann Emerg Med. 1995 Oct 1;26(4):429-33.

Study ObjectiveTo develop criteria that optimize clinical decisionmaking in the use of radiography after isolated knee trauma in adults.DesignA prospective survey of emergency department patients over a 7-month period. Standardized data forms were completed by emergency physicians, residents, and certified physician assistants.SettingA large suburban community teaching hospital.ParticipantsTwo hundred forty-two patients older than 17 years with isolated knee injuries sustained less than 24 hours previously.ResultsWe constructed a clinical decision model, calculating sensitivity, specificity, and odds ratios. Twenty-eight patients (11.6%) had fractures, with the patella the most commonly fractured osseous structure. Patients able to walk without limping had not experienced a fracture, nor had patients with twist injuries without effusion. Sensitivity of this model for detecting fracture was 1.0 (99% confidence interval, .97 to 1.0), and specificity was .337 (99% confidence interval, .26 to .42).ConclusionClinical decision rules are effective in detecting knee fractures with 100% sensitivity and with sufficient specificity to eliminate 29% of knee radiographs in the ED. These findings require prospective validation.

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