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Diagnostic accuracy of the Ottawa Knee Rule in adult acute knee injuries: a systematic review and meta-analysis

  • Emergency Radiology
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Abstract

Objectives

This systematic review and meta-analysis aimed to evaluate the current evidence on the diagnostic accuracy of the Ottawa Knee Rule (OKR) for acute knee injuries in adults.

Methods

A literature search of Embase (Elsevier), MEDLINE (U.S. National Library of Medicine), PubMed and Scopus databases (1995 to date; English language) was performed and the relevant references were assessed. Original articles documenting OKR use by emergency physicians to assess adult acute knee injuries were included. Study methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Results of eligible studies were pooled using random effects or fixed effects modelling to calculate the diagnostic performance of the OKR. The Higgins I2 test and Begg’s association test were performed to assess between-study heterogeneity and publication bias respectively, with Spearman’s correlation test for threshold effect.

Results

Eight studies, including 7385 patients, were enrolled and pooled using the random effects model. Sensitivity, specificity, negative likelihood ratio, positive likelihood ratio and diagnostic odds ratio were 0.99 (95% CI, 0.97 to 1.00), 0.49 (95% CI, 0.47 to 0.51), 0.07 (95% CI, 0.02 to 0.24), 1.86 (95% CI, 1.72 to 2.01) and 25.10 (95% CI, 7.18 to 87.70) respectively. Based on the QUADAS-2 criteria, most studies presented low risk of bias and concern regarding applicability.

Conclusions

Application of the OKR can rule out knee fracture and thus avoid unnecessary radiography. These results also translate to improved efficiency, lower medical costs and reduced waiting times.

Key Points

• The Ottawa Knee Rule helps clinicians to rule out fracture in adults with an acute knee injury.

• The rule allows a reduction in radiography requests, patient waiting time in the emergency department and healthcare costs.

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Abbreviations

ACR:

American College of Radiology

CT:

Computed tomography

DOR:

Diagnostic odds ratio

ED:

Emergency department

LR−:

Negative likelihood ratio

LR+:

Positive likelihood ratio

OKR:

Ottawa knee rule

PRISMA:

Preferred Reporting Items for Systematic Review and Meta-Analysis

QUADAS-2:

Quality Assessment of Diagnostic Accuracy Studies 2

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. School of Health Sciences, University of South Australia, 108 North Terrace, Adelaide, South Australia, Australia

    Jordan I. Sims & Minh T. Chau

  2. Medical Imaging Department, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia

    Josephine R. Davies

Authors
  1. Jordan I. Sims
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  2. Minh T. Chau
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  3. Josephine R. Davies
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Corresponding author

Correspondence to Minh T. Chau.

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Guarantor

The scientific guarantor of this publication is Minh Chau.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Minh Chau) has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because of the nature of our study, which was a systemic review and meta-analysis.

Ethical approval

Institutional Review Board approval was not required because of the nature of our study, which was a systemic review and meta-analysis.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Sims, J.I., Chau, M.T. & Davies, J.R. Diagnostic accuracy of the Ottawa Knee Rule in adult acute knee injuries: a systematic review and meta-analysis. Eur Radiol 30, 4438–4446 (2020). https://doi.org/10.1007/s00330-020-06804-x

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  • DOI: https://doi.org/10.1007/s00330-020-06804-x

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