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The Accuracy of the Ottawa Knee Rule To Rule Out Knee Fractures: A Systematic Review

Lucas M. Bachmann, MD, PhD; Sophie Haberzeth, MD; Johann Steurer, MD, MME; and Gerben ter Riet, MD, PhD
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From Zurich University, Zurich, Switzerland, and Academic Medical Center, Amsterdam, the Netherlands.

Acknowledgments: The authors thank Dr. Pius Estermann, information specialist at the hospital library, University Hospital, Zurich, Switzerland, for performing the literature searches.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Lucas M. Bachmann, MD, PhD, Horten Centre, Zurich University, Postfach Nord, CH-8091 Zurich, Switzerland; e-mail, lucas.bachmann@evimed.ch.

Current Author Addresses: Drs. Bachmann, Haberzeth, and Steurer: Horten Centre, Zurich University, Postfach Nord, CH-8091 Zurich, Switzerland.

Dr. ter Riet: Department of General Practice, Academic Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, the Netherlands.

Ann Intern Med. 2004;140(2):121-124. doi:10.7326/0003-4819-140-5-200403020-00013
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The introduction of new agents and regimens for the treatment of chronic hepatitis C, such as pegylated interferons and combination therapy with ribavirin, has resulted in substantial improvements in sustained virologic response rates. However, treatment remains a challenge, particularly for certain patient populations, because several virus-related and patient-related factors are associated with a lower virologic response to therapy. Hepatitis C virus genotype 1 and a high baseline viral load are the major viral factors associated with lower response. Patient-related factors include previous relapse or nonresponse to treatment, the presence of cirrhosis, African-American ethnicity, older age, contraindications to treatment, and obesity. This article reviews the data on interferon-based therapies among patients with lower chances for sustained virologic response and discusses the potential of the new pegylated interferons.


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Figure 1.
Description of the Ottawa knee rule for use of radiography in acute knee injuries.

Adapted from Stiell et al. (5). A knee radiograph series is required only for patients with knee injury who have any of these findings: 1) age 55 years or older; 2) isolated tenderness of patella [no bone tenderness of knee other than patella]; 3) tenderness at head of fibula; 4) inability to flex 90 degrees; or 5) inability to bear weight both immediately and in the emergency department for 4 steps (unable to transfer weight twice onto each lower limb regardless of limping).

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Figure 2.
Relation between the probability of knee fracture after a negative result on the Ottawa knee rule test and different fracture prevalences (assuming constancy of the negative likelihood ratio).
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Appendix Figure.
Flow chart of the study selection process.

CCTR = Cochrane Central Register of Controlled Trials; OKR = Ottawa knee rule.

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