Evaluation of the use of the Ottawa knee rules for acute knee injuries with military physicians which depend on BCRM Toulon and emergency departments of the south plateform

Objective The knee traumatology is an essential reason of consultation in general medicine and in emergency departments. The main interest of radiography is to look for fractures, unreduced dislocation or indirect signs in favor of one of these two diagnoses. Clinical rules exist for helping decision of complementary exams prescription: the Ottawa knee rules (OKR). First goal of this study is to assess the use of the OKR by the military doctors in acute knee injuries. Second goal is to assess items involved in the non-use of the Ottawa knee rules. Material/patients and methods Our study is an assessment of professional practices. The data collection was carried out from two questionnaires, which were sent by mail. The first one studied imaging prescribing criteria in acute knee injuries. The second one assessed the knowledge of OKR. Results Fifty-seven percent of interviewed physicians answered the first questionnaire and 78% answered the second one. The study shows that 12% of respondents know OKR. Seventy-one percent use at least 3 criteria. The average number of criteria other than Ottawa criteria is 7. None of the interviewed use exclusively. The most used Ottawa criterion is: impossible to walk 4 steps. The medical imaging prescribed at first intention is radiography in 94% of cases but it is also associated with another imaging in 41%. Eighty-two percent of physicians find OKR applicable in current practice. Sixty-one% who do not know these criteria would be ready to use them 82% of interviewed physicians find Ottawa knee rules applicable in current practice. Sixty-one percent of doctors who do not know these criteria would be ready to use them. Discussion – conclusion Twelve percent of French doctors know OKR. But they use these criteria without knowing them as such like our study. The lack of knowledge about criteria and medico-legal aspect are both the main limits according to the interviewed physicians. Using more these criteria could allow to decrease the cost and the duration of the medical care, and in this way have a public health impact. It could also have a public health benefit without altering the quality of the medical care. A better diffusion of the OKR could improve the knowledge and the acceptability of these criteria.