• Sanjit R Konda, Daniel Howard, Roy I Davidovitch, and Kenneth A Egol.
• Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York 10003, USA.
• J Orthop Trauma. 2013 Sep 1;27(9):491-7.

ObjectiveTo describe the use of the saline load test (SLT) using a new definition that more adequately characterizes its use in the emergency department (ED) setting.DesignRetrospective review.SettingLevel I trauma center.Patients/ParticipantsFifty consecutive patients who underwent an SLT of the knee in the ED and had a minimum of 14 days follow-up.InterventionSaline Load Test.Main Outcome MeasurementsPositive traumatic arthrotomy of the knee (+TAK) defined as operating room (OR) confirmation of an arthrotomy (assumed to develop a septic knee) or -SLT with follow-up revealing a septic knee. Periarticular wound equivalent to no traumatic arthrotomy of the knee [pw = (-TAK)] defined as OR evaluation revealing no arthrotomy (assumed not to develop a septic knee) or -SLT whose follow-up revealed no septic knee. Development of a septic knee was considered the gold standard for determining true positives/negatives and false positives/negatives.ResultsThe mean wound size was 3.9 ± 4.3 cm and the mean saline load volume was 74.9 ± 28.2 cm. There were 19 +SLTs of which there were 16 +TAK and 3 pw = (-TAK). The 3 pw = (-TAK) in the +SLT group were evaluated in the OR where inspection of the joint capsule revealed the absence of a traumatic arthrotomy. There were 31 -SLTs of which there were 1 +TAK and 30 pw = (-TAK). The SLT has a sensitivity of 94% and a specificity of 91% for detecting +TAKs and ruling out periarticular wounds not requiring surgical intervention [pw = (-TAK)]. The false-positive rate of the SLT to detect +TAK is 9%.ConclusionsUsing +TAK and pw = (-TAK) as the newly defined measures of the SLT, we report the sensitivity (94%) and specificity (91%) of the SLT in the ED setting while still maintaining the clinical relevancy of the test. Based on a small sample size, knees with small periarticular wounds and a -SLT and no other radiographic or clinical evidence of an arthrotomy appear to have an infection rate of 0% with nonoperative management.Level Of EvidenceDiagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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