URG-L: Pittsburgh Lions vs Ottawa Bears

[axel ellrodt]

Oui en comparaison pittsburgh est plus sensible, mais la question c'est "est-ce que vous urtilisez l'une ou l'autre oou le resultat le plus prudent de l'une et l'autre successivement ? (9. Seaberg DC, Yealy DM, Lukens T, et al: Multicenter comparison of two clinical decision rules for the use of radiography in acute, high-risk knee injuries. Ann Emerg Med 32:8-13, 1998   Full Text )   Annals of Emergency Medicine Volume 32 � Number 1 � July 1998 Copyright © 1998 American College of Emergency Physicians CLINICAL INVESTIGATION -------------------------------------------------------------------------------- Multicenter Comparison of Two Clinical Decision Rules for the Use of Radiography in Acute, High-Risk Knee Injuries David C Seaberg MD* Donald M Yealy MD Thomas Lukens MD, PhDII Thomas Auble PhD Susan Mathias RN§   From the University of Florida Health Science Center, Jacksonville, FL* ; the University of Pittsburgh Medical Center and Mercy Hospital,§ Pittsburgh, PA; and MetroHealth Medical Center, Cleveland, OH.II Received for publication September 7, 1996. Revisions received May 19, September 4, and December 29, 1997. Accepted for publication January 23, 1998. -------------------------------------------------------------------------------- Presented at the Society for Academic Emergency Medicine Annual Meeting, Denver, CO, May 1996. Copyright © 1998 American College of Emergency Physicians. Reprint no. 47/1/90757 -------------------------------------------------------------------------------- Address for reprints: David C Seaberg, MD, Division of Emergency Medicine, University of Florida Health Science Center, 655 West Eighth Street, Jacksonville, FL 32209 Study objective: Two separate clinical decision rules, one developed in Ottawa and the other in Pittsburgh, for the use of radiography in acute knee injuries have been previously validated and published. In this study, the rules were prospectively validated and compared in a new set of patients. Methods: A prospective, blinded, multicenter trial was conducted in the emergency departments of three urban teaching hospitals. A convenience sample of 934 patients with knee pain requiring radiographs was enrolled. A standardized data form was completed for each patient, comprising the 10 clinical variables included in the two rules. Standard knee radiographs were then taken in each patient. The rules were interpreted by the primary investigator on the basis of the data sheet and the final radiologist radiograph reading. Results: In the 745 patients in whom the Pittsburgh rules could be applied there were 91 fractures (12.2%). The use of the Pittsburgh rule missed one fracture, yielding a sensitivity of 99% (95% confidence interval [CI], 94% to 100%); the specificity was 60% (95% CI, 56% to 64%). The Ottawa inclusion criteria were met by 750 patients, with 87 fractures (11.6%). The Ottawa rule missed three fractures, for a sensitivity of 97% (95% CI, 90% to 99%); specificity was 27% (95% CI, 23% to 30%). Conclusion: Prospective validation and comparison found the Pittsburgh rule for knee radiographs to be more specific without loss of sensitivity compared with the Ottawa rule.     Denis Lockman a écrit : Il y a eu un article dans Annals comparant les deux, et la palme est allée à...  Pittsburgh.  Je trouve la référence et je la renvoie à la liste. Denis LockmanHôpital Montfort,Ottawa... ----- Original Message ----- From:axel ellrodt To: URG-L Mailing List Sent: 25 novembre, 2001 18:00 Subject: URG-L: Pittsburgh Lions vs Ottawa Bears  Utilisez-vous de façon systématique les règles d'Ottawa et / ou celles de Pittsburg dans les traumas du genou et pourquoi l'une plutôt que l'autre ? ou la "mieux-disante" pour un blessé donné ? rappel: Ottawa knee rules A knee radiograph is indicated only in patients with acute knee injuries and one or more of the following five conditions:   1.Blunt knee trauma in a patient > 55 years old   2.Tenderness of the head of the fibula on palpation   3.Isolated tenderness of the patella   4.Inability to flex the knee to 90 degrees   5.Inability to bear weight both immediately and inability to take four steps in the ED Exclusion criteria include:   1.Isolated skin injuries (i.e., superficial abrasions/lacerations)   2.Referred patients from another ED or clinic   3.Injury greater than 7 days old   4.Patient returning for re-evaluation   5.Distracting injuries (multiple trauma)   6.Altered mental status   7.Age < 18 years old   8.Pregnant patients   9.Paraplegia Pittsburgh decision rules Blunt trauma or a fall as mechanism of injury plus either of the following: Age younger than 12 years or older than 50 years Inability to walk four weight-bearing steps in the emergency department Exclusion criteria for the Pittsburgh Rules for Knee Radiographs include   1.Injury >6 days old   2.Isolated skin injuries (i.e., superficial abrasions/lacerations)   3.History of knee fracture or surgery 4.Repeat visit for the same injury -- Dr Axel Ellrodt Essonne, France http://zzorglub.ifrance.com/ Data, medical literature and links for emergency physicians. Un site pour urgentistes. Un sitio web para médicos de urgencias Lomana uebio nan partonagjatri -- Dr Axel Ellrodt Essonne, France http://zzorglub.ifrance.com/ Data, medical literature and links for emergency physicians. Un site pour urgentistes. Un sitio web para médicos de urgencias Lomana uebio nan partonagjatri