Bauer et al developed a decision rule for identifying patients needing X-rays of the knee after an acute injury. The study was done in Stony Brook at SUNY.
Patients with fractures were found more likely to have:
(1) severe joint line tenderness
(2) severe localized swelling
(3) an effusion
(4) ecchymosis
(5) flexion limited to < 90°
(6) inability to bear weight
Decision Rule for ordering radiographs: Radiographs done only if one or more of the following are present:
(1) inability to bear weight
(2) an effusion is present
(3) ecchymosis is present
Performance of rule:
• Bauer et al found the rule 100% sensitive for fracture
• Use of the rule allowed a 39% reduction in number of radiographs ordered without missing a fracture.
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