The Ottawa Knee Rule (OKR) is a clinical decision rule for the ordering of knee radiographs by physicians in @entity1 with blunt @entity3331 . However, in many Emergency Departments, radiographs are also ordered by nurses during triage. This study was designed to compare application of the OKR by triage nurses and physicians. A consecutive sample of all @entity1 presenting to the Emergency Department (ED) of a tertiary care military teaching hospital with blunt @entity3331 that met OKR inclusion criteria were enrolled. Radiographs were ordered on all @entity1 . Nurses and physicians were blinded to each other's examinations. Nurse-physician inter-reviewer reliability was compared using the kappa statistic. Of 172 enrolled subjects, 38 were excluded for incomplete data or multiple entries, leaving 134 study @entity1 . Four @entity174 (3%) were detected. Fair inter-observer reliability was found on four of the five OKR components: patellar tenderness (PT, kappa = 0.31), proximal fibula tenderness (PFT, kappa = 0.31), inability to flex > 90 degrees (FLEX, kappa = 0.24) and inability to walk four steps (WALK, kappa = 0.44). Nurses were more likely to overestimate the presence of individual components (PT 3.5x, @entity15795 6.6x, FLEX 1.9x and WALK 4.8x) and were 3.6 times more likely than Emergency Physicians (EP), overall, to order radiographs, representing a 21% vs. 37% reduced radiography rate, respectively. No @entity174 were missed by physicians or nurses. Triage nurses and EPs in this study had fair agreement in their application of the OKR. Triage nurses greatly overestimated @entity3331 , while maintaining sensitivity, at the expense of specificity and cost savings.

Ottawa Knee Rule: a comparison of physician and triage-nurse utilization of a decision rule for XXXX radiography.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity3331 :: ('MESH:D007718', 'Disease') :: ['knee injuries'] @entity15795 :: ('CHEBI:31263', 'Chemical') :: ['PFT'] @entity174 :: ('MESH:D050723', 'Disease') :: ['fractures']
@entity3331 :: (MESH:D007718,Disease) :: ['knee injury']
