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    Ottawa Knee Rule

    Describes criteria for knee trauma patients so low risk as not to warrant knee imaging.

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    Dr. Ian Stiell
    Dr. Ian Stiell
    From the creator
    Why did you develop the Ottawa Knee Rule? Was there a clinical experience that inspired you to create this rule for clinicians?
    We found that emergency doctors were ordering many imaging studies for knee injuries that were then found to be normal. I thought if there were a set of rules with criteria developed by emergency physicians, for emergency physicians, they would help this problem of unnecessary imaging and shorten emergency department wait times and costs.
    What pearls, pitfalls and/or tips do you have for users of the Ottawa Knee Rule? Are there cases when it has been applied, interpreted, or used inappropriately?
    As a general rule in the emergency department, x-rays are rarely useful because most injuries are soft tissue, and an x-ray does not show ligament injury.
    What recommendations do you have for health care providers once they have applied the Ottawa Knee Rule besides imaging, or when imaging is negative?
    If negative, the patient will inevitably need further assessment and follow-up to deal with soft tissue injuries and may even need an orthopedic consult.
    What are some situations in which you see clinicians interpreting the rule improperly or incorrectly leading to inappropriate x-ray utilization?
    Sometimes doctors don't properly assess the patient's ability to bear weight. Most patients can and will walk, but it may take a little encouragement from the physician.

    See More Info section for the definition of ability to bear weight.

    About the creator

    Ian Stiell, MD, MSc, FRCPC, is Professor and Chair, Department of Emergency Medicine, University of Ottawa; Distinguished Professor and University Health Research Chair, University of Ottawa; Senior Scientist, Ottawa Hospital Research Institute; and Emergency Physician, The Ottawa Hospital. He is internationally recognized for his research in emergency medicine with a focus on the development of clinical decision rules and the conduct of clinical trials involving acutely ill and injured patients treated by prehospital services and in emergency departments. He is best known for the development of the Ottawa Ankle Rule, the Canadian C-Spine Rule, and Canadian CT Head Rule and as the Principal Investigator for the landmark OPALS Studies for prehospital care. Dr. Stiell is the Principal Investigator for 1 of 3 Canadian sites in the Resuscitation Outcomes Consortium (ROC) which is funded by CIHR, NIH, HSFC, AHA, and National Defence Canada. Dr. Stiell is a Member of the Institute of Medicine of the U.S. National Academies of Science.

    To read more about Dr. Stiell's work, visit his website.

    Content Contributors
    • Calvin Hwang, MD
    About the Creator
    Dr. Ian Stiell
    Dr. Ian Stiell
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